Killer tips for Nephrostomy tube placement CPT Code

Nephrostomy tube placement CPT Code
Position of organs of the urinary tract (Kidney, Ureter, Urinary bladder, Urethra (Photo credit: Wikipedia)
As we know to study the retroperitoneal organs through x-ray imaging we have to perform diagnostic nephrostogram. Now, when we say about diagnostic procedures we are only finding the diagnosis. To solve the problem or diagnosis when have to perform some therapeutic or intervention procedures. Suppose, for example a patient is found diagnosed with hydronephrosis through diagnostic nephrostogram. So, to treat this hydronephrosis we have to place a tube called as nephrostomy tube. Nephrostomy tube placement is done to remove urine directly from the ureter if there is an obstruction in the urinary tract. These tips are really important for Certification exams like CPC, you can go through sample CPC questions here which will surely help in clearing CPC exam.

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Procedure performed during Nephrostomy tube placement

The procedure is performed under intravenous conscious sedation. Then the patient is injected with local anesthetic agent. Under sterile condition a needle in inserted into renal pelvis under fluoroscopic guidance. Once, the needle is at proper position, a guide wire is inserted along the needle. The needle is removed and then a nephrostomy tube or catheter is inserted through the guide wire. Then the guide wire is removed. A contrast is injected through the nephrostomy tube to take fluoroscopic images of kidneys, this is called antegrade nephrostogram. Now, once there is any abnormality found through nephrostogram it is treated with Nephrostomy tube placement.

Nephrostomy tube placement CPT Code

In medical coding, we have direct codes for diagnostic procedure as well as for therapeutic procedures. Now, the only problem is when to code diagnostic and therapeutic procedures together, Antegrade or diagnostic Nephrostogram is performed depending on the situation. Nephrostogram is performed for final checking of position of nephrostomy catheter or tube and also for finding out any abnormality in kidney or urinary tract. So, please check while coding diagnostic nephrostogram along with nephrostomy tube placement CPT Code. Always check for any diagnostic finding like kidney stone, ureteric obstruction or hydronephrosis, while coding diagnostic nephrostogram.

NCCI edit between nephrostogram and Nephrostomy tube placement CPT Code.

As I have told nephrostogram, cpt code 50390, is also performed while placing nephrostomy tube placement, cpt code 50392, to check it final position. As it is necessary to perform  nephrostogram whenever a nephrostomy tube is placed, so it is always included in nephrostomy tube placement CPT Code 50392. It is not coded separately with 50392 in this scenario.
But when we have diagnostic finding while performing nephrostogram, we have to code 50390 along with nephrostomy tube placement cpt  code. Now, as we are coding an included exam, here 50390, with a major exam, here 50392, we have to show them as distinct procedure from one another. So, whenever we are coding 50390 with 50392 we have to use modifier 59 for distinct procedure with the cpt code 50390.  
Now, I hope you are clear when to code nephrostogram with nephrostomy tube placement cpt code. If you liked the article do share it please.

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