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

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

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

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

5. 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

6. 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

7. Consensus Pyeloplasty 50405 23.89 Intercostal nerve block 64421 1.68
?? Open insertion of ureteral stent

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

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

10. 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
50605 Ureterotomy for insertion of indwelling stent, all types 15.44

11. 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
50605 Ureterotomy for insertion of indwelling stent, all types 15.44

12. 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 OR
?? Renal endoscopy through nephrotomy or pyelotomy, with ureteral catheterization, with or without dilation of ureter

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

14. 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 ??

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

16. 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

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

18. 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

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