With Medicare payments continuing to fall further below rates established over a decade ago—and with little to no action by lawmakers to provide relief—reimbursement in 2025 remains under constant threat, making accurate coding more essential than ever, especially for genitourinary procedures. Expertly answered FAQs address common challenges such as coding for access tract creation, interpreting ileal conduit imaging, and distinguishing between catheter and stent placements. These expert insights help ensure compliant, optimized coding in today’s complex healthcare landscape. Our nationally renowned subject matter experts have compiled critical FAQs based on challenges they encounter every year across the country, helping you to overcome obstacles and achieve success in 2025.
Frequently Asked Questions for Accurate and Enhanced Understanding
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 physician needs to re-establish tract access to place a new nephrostomy tube, this would be coded as a new placement with code 5043.
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.
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