Coding for Kidney, Ureter and Bladder Procedures Jack S. Elder, M.D., FAAP

Case 1: Infant with UPJ obstruction Open dismembered pyeloplasty Insertion of double J stent (through open ureter) Intercostal nerve block

Pyeloplasty Codes 50400 Pyeloplasty (Foley Y-pyeloplasty), plastic operation on ureter, nephropexy, nephrostomy, pyelostomy, or ureteral splinting, simple 19.47 50405 Pyeloplasty complicated (congenital kidney abnormality, secondary pyeloplasty, solitary kidney, calycoplasty) 23.89

Pyeloplasty Codes 50400 Pyeloplasty (Foley Y-pyeloplasty), plastic operation on ureter, nephropexy, nephrostomy, pyelostomy, or ureteral splinting, simple 19.47 50405 Pyeloplasty complicated (congenital kidney abnormality, secondary pyeloplasty, solitary kidney, calycoplasty) 23.89

Ureteral Stenting Codes 50605 Ureterotomy for insertion of indwelling stent, all types 15.44 50393 Introduction of ureteral catheter or stent into ureter through renal pelvis for drainage and/or injection, percutaneous 4.15

Nerve Blocks 64420 Intercostal nerve, single 1 level 1.18 64421 Intercostal nerve, multiple, regional block 1.68 0.125% bupivacaine with 1:200,000 epinephrine 64425 Ilioinguinal, iliohypogastric nerves 1.75

Consensus Pyeloplasty 50405 23.89 Intercostal nerve block 64421 1.68 ?? Open insertion of ureteral stent 50605 15.44

Case 2: 10 yo child with UPJ obstruction Cystoscopy, insertion of ureteral catheter Laparoscopic dismembered pyeloplasty Antegrade insertion of double J stent

Laparoscopic Pyeloplasty 50544 Laparoscopy, pyeloplasty 22.37 52005 Cystourethroscopy, with ureteral catheterization 2.37

Ureteral Stenting Codes 50393 Introduction of ureteral catheter or stent into ureter through renal pelvis for drainage and/or injection, percutaneous 4.15 50572 Renal endoscopy through nephrotomy or pyelotomy, with or without irrigation, instillation or ureteropyelography, with ureteral catheterization, with or without dilation of ureter 10.33 50605 Ureterotomy for insertion of indwelling stent, all types 15.44

Ureteral Stenting Codes 50393 Introduction of ureteral catheter or stent into ureter through renal pelvis for drainage and/or injection, percutaneous 4.15 50572 Renal endoscopy through nephrotomy or pyelotomy, with or without irrigation, instillation or ureteropyelography, with ureteral catheterization, with or without dilation of ureter 10.33 50605 Ureterotomy for insertion of indwelling stent, all types 15.44

Consensus 50544 Laparoscopy, pyeloplasty 22.37 52005 Cystourethroscopy, with ureteral catheterization 2.37 50393 Introduction of ureteral catheter or stent into ureter through renal pelvis for drainage and/or injection, percutaneous 4.15 OR ?? Renal endoscopy through nephrotomy or pyelotomy, with ureteral catheterization, with or without dilation of ureter 10.33

Case 3: 4-year-old boy with refluxing megaureter Ureteral tapering Ureteral reimplantation with psoas hitch Insertion of double-J catheter

Pertinent Ureteral Tailoring Codes 50700 Ureteroplasty, plastic operation on ureter (e.g., stricture) 15.19 50783 Ureteroneocystostomy, anastomosis of single ureter to bladder with extensive ureteral tailoring 20.52 50785 Ureteroneocystostomy, anastomosis of single ureter to bladder with vesico-psoas hitch or bladder flap 20.49 ??50785-22

Consensus 50785 Ureteroneocystostomy, anastomosis of single ureter to bladder with vesico-psoas hitch or bladder flap 20.49 50700 Ureteroplasty, plastic operation on ureter (e.g., stricture) 15.19 50605 Ureterotomy for insertion of indwelling stent, all types 15.44

Open excision of ureterocele Upper-to-lower ureteroureterostomy Case 4: 3 yo girl S/P TUI ureterocele as infant; has functioning RUP and reflux into upper and lower poles Cystoscopy Open excision of ureterocele Upper-to-lower ureteroureterostomy Ureteral reimplantation, lower pole ureter

Consensus 52000 Cystoscopy 2.01 51535 Cystotomy for excision, incision, or repair of ureterocele 12.55 50760 Ureteroureterostomy 18.39 50780 Ureteroneocystostomy, anastomosis of single ureter to bladder 18.33

Open excision of ureterocele Tapering of upper pole ureter Case 5: 3 yo girl S/P TUI ureterocele as infant; has functioning RUP and reflux into upper and lower poles Cystoscopy Open excision of ureterocele Tapering of upper pole ureter Common sheath ureteral reimplantation Insertion of double-J stent

Consensus 52000 Cystoscopy 2.01 51535 Cystotomy for excision, incision, or repair of ureterocele 12.55 50783 Ureteroneocystostomy, anastomosis of single ureter to bladder with extensive ureteral tailoring 20.52 (alt. 50700 + 50782) 50605 Ureterotomy for insertion of indwelling stent, all types 15.44