When to Code Nephrostomy tube exchange CPT and Nephrostogram together


New CPT codes in 2016 for Nephrostogram and Nephrostomy tube placement


In 2016, there are many changes in coding Nephrostogram procedures. The new Codes in 2016 will have bundled codes and will include the supervision and interpretation procedure as well. Old CPT codes will be deleted and new Bundled CPT codes will replace them. CPT code 50394, 50392, 74475, 50393, 74480, 50398 have been deleted. There are many new CPT codes have replaced them. Check my blog post on new CPT codes for nephrostogram in 2016 to know about the new CPT codes.
When to Code Nephrostomy tube exchange CPT and Nephrostogram together

CPT code for Nephrostomy tube


CPT code 50398 (code deleted in 2016 and replaced by 50434 & 50435) is used to code nephrostomy tube exchange. The exchange of tube happens when there is complication with the tube placement. Now, here we can have different reasons for the change of nephrostomy tube. Since, we are using multiple Procedure codes together we have to assign modifiers to be paid for all the procedure codes. Now we will see when to code nephrostomy tube placement codes should be coded with exchange of nephrostomy tube CPT codes.





First scenario

When there is nephrostomy tube is placed we code CPT code 50392 (code deleted in 2016 and replaced by 50432) . Now, after few days if some complication occurs with the nephrostomy tube and we have to replace it. In such situation, we have to code 50398 CPT code for nephrostomy tube exchange. In the nephrostomy exchange if we do not find any new sign and symptoms related to tube exchange we would go ahead and code only nephrostomy exchange. The symptoms or findings may be ureteric obstruction, renal stone, hydronephrosis etc. But if any of the symptoms are not related we are not supposed to code 50394 (injection procedure for pyelography through a nephrostomy or pyelostomy tube) along with 50398.

Second scenario

Now when there are finding or symptoms related to tube during exchange, we have to assign both 50394 (injection procedure for pyelography through a nephrostomy or pyelostomy tube) and 50398 together. The main thing to observe here is just to find any finding present after injection of contrast through nephrotomy tube. If there are any symptoms or finding present, we will go ahead and assign 50394 CPT code along with nephrosotomy exchanges CPT code 50398. These two CPT codes have CCI edit and hence to bypass them we have to use 59 modifier with 50394.


Diagnosis coded for nephrostomy exchange cpt code


When there are complications, we use to go assign Nephrostomy complication diagnosis code. When there are no complications, we have to only attention to nephrostomy icd code. Below are the icd9 and icd 10 codes commonly used for nephrostomy tube placement.

Complication ICD 10 codesComplication ICD 10 codes

996.76                Other complications due to genitourinary device, implant, and graft
 

T83.81XA    Embolism of genitourinary prosthetic devices, implants and grafts, initial encounter
 

T83.82XA    Fibrosis of genitourinary prosthetic devices, implants and grafts, initial encounter
 

T83.83XA    Hemorrhage of genitourinary prosthetic devices, implants and grafts, initial encounter
 

T83.84XA    Pain from genitourinary prosthetic devices, implants and grafts, initial encounter
 

T83.85XA    Stenosis of genitourinary prosthetic devices, implants and grafts, initial encounter
 

T83.86XA    Thrombosis of genitourinary prosthetic devices, implants and grafts, 
initial encounter
 

T83.89XA    Other specified complication of genitourinary prosthetic devices, implants and grafts, initial encounter
 

T83.9XXA    Unspecified complication of genitourinary prosthetic device, implant and graft, initial encounter
Non-Complication ICD 10 codes

V55.6 Attention to Nephrostomy tube
 

Z43.6 Encounter for attention to other artificial openings of urinary tract

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2 comments

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30 July 2015 at 05:47 delete

Is this a typo? The correct code for percutaneous neph tube insert is 50392. I agree completely with the rest of your text.

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21 December 2015 at 06:42 delete

thanks for valuable comment..i have corrected the typo error for CPT code for Nephrostomy tube placement 50392...

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