GENITOURINARY SYSTEM (GU)

Non Vascular Interventional Coding

Genitourinary System (GU)

      There are various non vascular Interventional procedures are performed for various conditions which are related to GU system are mentioned below, some of the common Terminology are:

Pyelography:  X ray images of the renal pelvis of the kidney with associated structures after administration of a contrast agent.

Nephrostomy tube:  A very small, soft, plastic tube, which is placed into the renal collecting system for temporary drainage of urine, abscess, or calculus removal.

Pyelostomy tube:   A plastic tube which is placed in the renal pelvis of the kidney for drainage of urine. It is placed either percutaneously or during an open surgical procedure.

Nephrostogram:   An X ray of the kidney after injection of a contrast agent.

Pyeloureterogram:  An X ray of the kidneys, renal pelvis, and ureters after injection of a contrast agent.

Percutaneous Antegrade Pyelogram

A Percutaneous Antegrade Pyelogram  is performed by placing a needle into the kidney or kidney cyst with injection of contrast and taking images.

 CPT 50390- Aspiration and/or injection of renal cyst or pelvis by needle, percutaneous
 For radiological S&I, - 74425,74470, 76942, 77002, 77012, 77021. 

Note:
Don't assign antegrade pyelogram if contrast injection was performed for the purpose of
localization of a posterior calyx for subsequent Percutaneous nephrostomy tube placement.

Nephrostomy Tube Placement

Renal collecting system obstruction would be the major reason behind the placement of Percutaneous nephrostomy tube placement. The procedure consist of placement of a drainage tube into the collecting system of an obstructed kidney. The tube is sutured in place and drains to a bag at the patient’s side.

CPT 50392 - Introduction of intracatheter or catheter into renal pelvis for drainage and/or injection, percutaneous

For radiological S&I, - 74475, 76942, 77012

Note:
If both a diagnostic antegrade pyelogram and a nephrostomy tube placement are performed at
the same session, code 50392 and 50390 with 59 modifier along with appropriate S&I codes.

(The diagnostic antegrade pyelogram is via the initial needle puncture of the collecting system, followed by a new separate percutaneous puncture of a posterior calyx for placement of the drainage catheter)

Nephrostogram

Malfunctioning drainage tube or any complication would be the reason for Nephrostogram procedure following prior Percutaneous nephrostomy tube placement. Nephrostogram involves injection of contrast into a newly placed or pre-existing kidney drainage tube and analyze the internal structures of the kidney, renal pelvis, and/or ureter using imaging guidance.

 

CPT 50394 - Injection procedure for pyelography (as nephrostogram, pyelostogram, antegrade pyeloureterograms) through nephrostomy or pyelostomy tube, or indwelling ureteral catheter

 

For radiological S&I, - 74425

 

Note:  If a tube check or change is performed with the patient in the supine position, it is  via an ileal conduit and is coded with 50684 or 50688.

 

           If a tube check or change is performed with the patient in the prone position, the procedure is performed via flank and is coded with 50394. 

 

Nephrostomy Tube change

Non-functioning nephrostomy tube is the reason behind the Nephrostomy Tube change, Nephrostomy tube is evaluated first by administrating contrast through the existing Nephrostomy Tube (NEPHROSTOGRAM) and The exchange portion of the exam occurs when a wire is placed through the existing tube and the tube is removed, followed by placement of a new tube into the kidney over the wire.

 

CPT 50398 - Change of nephrostomy or pyelostomy tube

 

For radiological S&I, - 75984

 

Note: In case contrast was not documented don't assign 75984 instead can code 76000.