Laparoscopy Coding: 50544: Let 3 Scenarios Direct Your UPJ Obstruction Coding

Don't lose out on additional procedures as well as services for which you deserve reimbursement.

Laparoscopic procedures are becoming more usual in urology practices as well as pyeloplasty procedures are certainly no exception. Don't let this new surgical technique have adverse effect on your medical coding and cost your practice money. Take a look at three common clinical scenarios in coding pyeloplasty procedures to correctly apply ICD-9 and CPT codes.

Look for Bundles Involving Laparoscopic Pyeloplasty

Scenario 1: Your urologist carries out a laparoscopic pyeloplasty which is meant for a UPJ obstruction. He also executes a preoperative cystoscopic examination as well as retrograde pyelogram and keeps a double J stent.

First: In this case you must bill first for the highest paying service, the laparoscopic pyeloplasty (50544, Laparoscopy ,surgical, pyeloplasty) as your primary procedure code. The suitable ICD-9 diagnosis code is 753.21 (Congenital obstruction of ureteropelvic junction).

Then you must bill for the insertion of the JJ stent by means of 52332 (Cystourethroscopy, with insertion of indwelling ureteral stent [e.g., Gibbons or double-J type]). Append modifier 51 (Multiple procedures) in case your payer needs that modifier for multiple procedures performed during the same session and assign ICD-9 codes 591 (Hydronephrosis) and V07.8 (Other specified prophylactic or treatment measure).

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Add All Renal Procedure Codes When Carried Out

Scenario 2: Your urologist carries out a renal endoscopy through a formerly placed established nephrostomy site, gets rid of a small renal pelvic stone, replaces the nephrostomy tube, and carries out a nephrostogram revealing a ureteropelvic junction obstruction. He then chooses to execute a laparoscopic pyeloplasty meant for a UPJ obstruction.

Start the same way: Similar to the first scenario, you'll first report 50544 for the laparoscopic pyeloplasty as that code again carries the highest relative value units (RVUs). Again, you'll use 753.21 as the ICD-9 diagnosis code.

Next, you must report 50561 (Renal endoscopy through established nephrostomy or pyelostomy, including or excluding irrigation, installation, or ureteropyelography, exclusive of radiologic service; with removal of foreign body or calculus) for the renal endoscopy with stone removal. Append modifier 51, if required.

ICD-9 and CPT Coding Tip: You can moreover bill the removal and replacement of the nephrostomy tube with 50398 (Change of nephrostomy or pyelostomy tube). Attach 51, if your payer requires that modifier. Assign ICD-9 diagnosis code 591 to 50398.

Confront Vessel Excision With 50544

Your urologist executes a laparoscopic pyeloplasty for a patient with a UPJ obstruction. He also carries out an excision of crossing venous vessels. Prior to the procedure he also executes a preoperative cystoscopic examination and retrograde pyelogram and then he places a double J stent.

ICD-9 and CPT Coding Tip: Stick with 50544: Similar to the last two scenarios, you'll report the laparoscopic pyeloplasty as the primary procedure by means of 50544 with ICD-9 diagnosis code 753.21.

After that you must report 55550 (Laparoscopy, surgical, with ligation of spermatic veins for varicocele) for the excision of crossingvenous vessels. Attach 51 if required. You'll assign ICD-9 diagnosis code 747.62 (Renal vessel anomaly) for this diagnosis.