Q & A with Dr. Z – Nephrostomy Tract Dilation with NU Cath Placement Earlier Same Day

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by David Zielske, MD, CIRCC, COC, CCVTC, CCC, CCS, RCC

Question: Radiologist placed nephroureteral catheter at 9 AM. At 1 PM on the same day, the nephroureteral catheter was removed by the radiologist, the renal tract dilated to 30 French by the radiologist, then a stone extraction was performed by the Urologist.

Following the stone removal, a nephroureteral catheter was positioned into the distal ureter and a 10 French JJ stent of similar length was then placed with its tip in the urinary bladder and proximal aspect in the right renal pelvis (by the radiologist).

What is the correct coding (including modifiers) for the procedures performed at different sessions on the same date of service?

Answer: The radiologist can report 50433 for the initial percutaneous nephroureteral catheter placement. Later in the day the same radiologist, at a separate session, can report the dilation of the tract via the existing access with 50436-XE. If the urologist did the dilation of the tract at the same session as the stone extraction, the urologist cannot report the dilation code, just the stone extraction code.

The placement of the double J and the new percutaneous nephroureteral catheter after the stone extraction are part of both 50436 and 50437 and 50080 (50081), so those additional drainage procedures at the end of the case cannot be reported regardless of which physician placed them.  


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About the Author

David Zielske is founder and President of ZHealth Publishing and primary author and editor of ZHealth publications. Dr. Z practiced as an interventional radiologist and has over twenty years experience as a coding reviewer and coding expert. He is Board Certified in Radiology and has functioned as an independent interventional radiology, vascular surgery, and cardiovascular coding consultant to a variety of physician groups and hospital providers across the country. He also served as an instructor for over 200 coding seminars.

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