Reimbursement remains in an era of constant threat, making accurate coding more important than ever before. In the complex realm of medical coding for genitourinary procedures, understanding the nuances between terms like ‘catheter’ and ‘stent’ is crucial. Frequently Asked Questions (FAQs), received, identified, and answered by our subject matter experts from professionals across the nation, play a pivotal role in clarifying these distinctions. Take, for instance, the differentiation between a ‘catheter’ and a ‘stent’ in genitourinary procedures. While historically used interchangeably, a ‘stent’ now refers to a wholly internal device, whereas a ‘catheter’ implies a device with an external portion. This subtle yet significant difference underscores the necessity for precise documentation, ensuring accurate code assignment. These distinctions, highlighted in FAQs, illuminate the coding intricacies that guide medical coding and compliance professionals in accurately reporting procedures and ultimately optimizing healthcare reimbursement for a successful 2024.
What is the difference between a ‘catheter’ and a ‘stent’ in genitourinary procedures?
Traditionally, ‘catheter’ and ‘stent’ have been used somewhat interchangeable, but, for the purposes of genitourinary procedure codes stent is used for a completely internal device, no portion remains outside the body while catheter indicates that a portion of the device does remain outside the body. The documentation must be clear so that, despite the term used by the physician, the correct code may be assigned.
For example, if the documentation states the placement of a nephroureteral stent that has one end in the bladder and the other connected to a drainage bag, this would be coded as a nephroureteral catheter placement, not a stent placement, despite the use of the term stent.
How would you code when a radiologist is asked to create a new access, or enlarge an existing access, for a urologist to perform subsequent endourologic procedures?
If there is an existing nephrostomy tube or nephroureteral catheter and that tract is enlarged by the radiologist to allow the surgeon to use larger instruments during an endourologic procedure, such as a kidney stone removal, this is reported with code 50436. When there is no existing nephrostomy tube or nephroureteral catheter and the radiologist must create the access as well as dilate the tract for the surgeon, this is reported with code 50437. Some phrases to look for in documentation to identify these procedures include balloon dilator, serial dilators or sheath.
Neither of these codes should be used for the normal dilation of the tract for placement of a nephrostomy tube or nephroureteral catheter. Normal, basic dilation is included in the placement codes 50432, 50433, or 52334.
What if the radiologist is asked to create a new access without dilation to place a wire only into the bladder for a urologist to perform a subsequent endourologic procedure?
For this scenario, it is recommended to report unlisted procedure code 53899.
What is the correct way to code for an imaging study of an ileal conduit when the injection is performed near where the conduit empties into the external drainage bag (i.e., the skin side of the conduit)?
The correct codes to submit when imaging of the conduit is performed from this approach would be 74420 and 50690.
If a patient presents for a nephrostomy tube exchange but the tube fell out at home, should this be coded as a new placement (50432) or as an exchange (50435)?
If the existing nephrostomy tract is patent and the new nephrostomy tube is easily introduced, exchange code 50435 is recommended. If the existing tract is closed and the physician needs to re-establish tract access to place a new nephrostomy tube, this would be coded as a new placement with code 50432.
What are some of the other ways genitourinary procedures may be described in documentation?
Different physicians may use different terms to describe the same procedures in the genitourinary system, some common ones include the following:
| Indicator | Item/Code/Service | OPPS Payment Status |
| 50693- 50695 | Placement of a ureteral stent (completely internal device) | J-J stents •Pigtail stents •Double-J stent •Double pigtail stent |
| 50433 | Placement of a nephroureteral drainage catheter that combines a ureteral catheter and a nephrostomy catheter into a single catheter for external and/or internal drainage | •Internal/external catheter •Nephroureteral catheter •Nephroureteral stent •Universal stent |
| 50432 | Percutaneous placement of a nephrostomy tube into the kidney for drainage | •Perc nephc •PCN •Percutaneous nephrostomy |
| 50690 +74425 | Ureterostomy – the ureters are detached from the bladder and attached directly to a stoma in the abdominal wall | •Loopogram •Ileal loop stud |
These are NOT all the tips and tricks necessary for genitourinary IR coding.
As service volumes rebound and every dollar of reimbursement counts more than ever in the face of payment cuts, it’s imperative to make sure your CPT® coding is correct and compliant. Master more IR coding topics and break down the complexity with our expert-infused 2024 Genitourinary Interventional Radiology Coding webcast live on May 15, 2024, or on-demand past this date. This webcast is an essential training tool for both audio and visual learners.
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