Q&A: CPT codes for removing kidney stones

Q: If a physician performs a lithotripsy on a stone in the ureter or removes a stone from the ureter through a transurethral approach, then performs a percutaneous nephrostomy and treats a stone in the kidney, would both procedures be reported?

A: Yes. Per the 2023 CPT guidelines at the beginning of the “Kidney” section, “Placement of additional accesses, if needed, into the kidney, and removal of stones through other approaches (e.g., open or retrograde) may be reported separately, if performed.”

 Therefore, the coder would report one of the following codes for the percutaneous nephrostomy:

• 50080, percutaneous nephrolithotomy or pyelolithotomy, lithotripsy, stone extraction, antegrade ureteroscopy, antegrade stent placement and nephrostomy tube placement, when performed, including imaging guidance; simple (e.g., stone[s] up to 2 cm in single location of kidney or renal pelvis, nonbranching stones)
• 50081, …; complex (e.g., stone[s] greater than 2 cm, branching stones, stones in multiple locations, ureter stones, complicated anatomy)

The coder would then add one of the following codes for the transurethral approach, depending on if the surgeon performs a ureteroscopy or pyeloscopy and if he or she advances the lithotripsy probe through a cystoscope or ureteroscope to fragment the calculus:

• 52325, cystourethroscopy (including ureteral catheterization); with fragmentation of ureteral calculus (e.g., ultrasonic or electro-hydraulic technique)
• 52353, cystourethroscopy, with ureteroscopy and/or pyeloscopy; with lithotripsy (ureteral catheterization is included)

However, depending on which codes are used, the coder should check the NCCI edits to ensure if a modifier, such as modifier -59 (distinct procedural service) or -51 (multiple procedures) is appropriate to append. These codes may come up bundled in the NCCI edits, but they can be over-ridden with modifier -59, if appropriate.  If modifier -59 is not appropriate to the case, then it should not be added, or payment expected. 

Editor’s note: This article originally appeared in JustCoding. This question was answered by Lori-Lynne A. Webb, CPC, CCS-P, CCP, CHDA, COBGC, AHIMA-approved ICD-10-CM/PCS trainer for Saint Alphonsus Regional Medical Center in Melba, Idaho.