CPT codes 50386 and 50385 should not be reported without the use of anesthesia and imaging in a dedicated interventional-type suite. There are a number of different CPT codes that can be used to describe and bill the work for stent removal, but understanding their use is vital for proper coding and reimbursement.
The above description is abbreviated. The wound repair would be considered to be included in the foreign body removal code. Use fluoroscopy to monitor the progress of the stent as you slowly withdraw it from the kidney. The above description is abbreviated. Therefore, […] Similarly, there is no CPT code to report the blind grasping of a dangle within the urethra using a tool to grasp the dangle. Subscribers will be able to see codes in a code-book page-like view here. Re-introduce the cystoscope and inspect the bladder to assure no perforations or bleeding, then empty the bladder completely and slowly withdraw the cystoscope. If appropriate, insert a urinary catheter for postoperative drainage.” Due to this wording, CPT code 52310 would be billed once even for bilateral ureteral stent removal, and no modifier should be used in an attempt to bypass the edit. If a patient has a stent removed at the time of an evaluation and management visit, the removal is integral to the evaluation and management service. You may, however, use the code for deep foreign body removal from the foot (28192) or the code for complicated foreign body removal from the foot (28193) as appropriate (Table 1). These codes are appropriate to use only when the procedure is performed via a transurethral approach, without the use of cystoscopy. A Based on your question, we are going to assume you are using a cystoscope that is inserted through an established suprapubic tract to locate and remove the stones.
Personally, I'm not crazy about 54440 either because there is no mention that the penis was injured. The other code that I would look at is 54115 removal foreign body from deep penile tissue.
I'd probaby 53899 and compare to 54115. CPT codes 50386 and 50385 are a codes that are mostly typically billed by an interventional radiologist or an urologist with access to an interventional radiology-type suite. CPT codes 50386 and 50385 should not be reported without the use of anesthesia and imaging in a dedicated interventional-type suite. JavaScript is disabled. For coding purposes, an ileal conduit and neobladder is considered the urinary bladder. CPT code 52310 is also the code used for simple removal of bladder stones or a bladder foreign body. CPT 52310 Cystourethroscopy, with removal of foreign body, calculus, or ureteral stent from urethra or bladder (separate procedure); simple. For a better experience, please enable JavaScript in your browser before proceeding. Beware of outside advice on the use of CPT codes as sometimes the advice may not be completely appropriate. All Rights Reserved. I'm guessing that 52310(Simple) or 52315(Complicated) would be a better fit as it deals with Foreign bodies in the Urethra. I could really use some help with this one. CPT 52315 Cystourethroscopy, with removal of foreign body, calculus, or ureteral stent from urethra or bladder (separate procedure); complicated. 52310 and 52315 would not be approrpriate because these codes use the cystourethroscope to retrive the foreign body.
View historical information about the code including when it was added, changed, deleted, etc. Re-introduce the cystoscope, inspect the bladder, assure that there is efflux from that ureteral orifice, and irrigate the bladder using a Toomey syringe until all of the stone material has been removed.” This code should not be used for the removal of an encrusted stent that is easily removed, nor for the removal of bilateral stents; CPT code 52310 should be used for those instances. ©2019 American Urological Association. If there are questions, consult the AUA Coding Hotline. This code description may also have, ICD-9 & ICD-10 Cross-A-Code™ (GEMs & RMs), reverse_index/reverse_index_content.php?set=ICD9V3&c=98.19, dictionaries/dictionary_content.php?set=ICD9V3&c=98.19, drg/drg_content_icd9.php?set=ICD9V3&c=98.19, commercial-payers/commercial-payers-content.php?set=ICD9V3&c=98.19, NPI Look-Up Tool (National Provider Identifier). This code description may also have Includes, Excludes, Notes, Guidelines, Examples and other information. 3 Procedure Codes I would go with 54440 plastic operation of penis for injury because this code is paid on a case by case basis.
Although the descriptor of a CPT code may seem to describe a particular procedure, it is important to fully understand the appropriate use of CPT codes. Similarly, the provider may “Re-grasp the stent as often as necessary to try and remove the visible stone material, with the goal of atraumatically removing the stent intact from the ureter. You must log in or register to reply here. What is a good CPT code to use for this???? There is no CPT code that describes the work to remove a stent or catheter that is exiting the patient and accessible. The work includes anesthesia and fluoroscopy. It may not display this or other websites correctly. All I have is 51702. Specifically, “under appropriate sedation and using sonographic guidance, a rigid biopsy forceps is introduced through the urethra, advanced to the urinary bladder, and the stent is grasped and removed.” The physician removes (50386) or removes and replaces (50385) an internally dwelling ureteral stent. You are using an out of date browser. There is apparently a knot in the tubing at the level of the proximal pendulous urethra. Note: Stent removal (such as CPT 52310) and stent placement (CPT 52332) are cannot be reported at the same setting and in the case of removal and replacement of an indwelling ureteral stent, only CPT 52332 Cystourethroscopy, with insertion of indwelling ureteral stent (e.g., Gibbons or double-J type) should be reported. Subscribers may add their own notes as well as "Admin Notes" visible to all subscribers in their account. Thank you for choosing Find-A-Code, please Sign In to remove ads. Thanks in advance for your help. There are unique CPT® codes used for billing the placement, removal and exchange of ureteral catheters and stents. 98.19 Removal of intraluminal foreign body from urethra without incision - ICD-9-CM Vol. Oh good point, I totally missed the incision. The code requires and includes performing a complete cystoscopy (CPT 52000), which cannot be billed separately, and therefore documentation should include the results of an examination of the urethra (such as for strictures), the prostate (in men) and the bladder (such as for mucosal lesions, neoplasms or stones).