Can you bill 50605 as well as for stent placement through a ureterotomy?

I have a two-part question for you. First, if you perform a laparoscopic pyeloplasty, can you bill 50605 as well as for stent placement through a ureterotomy? My hospital system is saying they are bundled, but I don’t think they are. Second, when I do a ureteroureterostomy, I feel code 50605 should be allowed, but they keep denying my coding. Can you help me to set the record straight?

Regarding your first question, the description of 50544—Laparoscopy, surgical; pyeloplasty—does not include insertion of a stent in the description. Nor is there a different code that would include both the stent insertion and pyeloplasty. Therefore, from a CPT coding perspective, it is appropriate to look for a code that would describe the insertion of a stent to report in addition to the laparoscopic pyeloplasty.

Unfortunately, CPT does not include a code for laparoscopic insertion of stent.

Expanding the search, we find two potential codes that could be considered: 50605 (Ureterotomy for insertion of indwelling stent, all types) and 50949 (Unlisted laparoscopy procedure, ureter). Choosing which code to use is a bit of debate. Code 50605 does not specify approach in the description. The AUA has recommended in other cases for circumstances in which there is no existing laparoscopic code for the procedure performed, with payer notification, a code considered to be traditionally provided with open approach but without a specified approach in the descriptor can be reported for the service. Note that payer notification is recommended prior to reporting the service. Many groups are successfully reporting in this manner.

However, for those instances where the payer prefers the use of the unlisted code or in circumstances in which the compliance program for the billing entity requires reporting of the unlisted code specifying approach, the unlisted code with reference to the compatible open code should be reported.

Neither of the codes are considered bundled with the pyeloplasty code in the National Correct Coding Initiative (NCCI) bundling edits.

Therefore, you should charge separately for the insertion of the stent when medically necessary. It should be noted that not all payers conform to NCCI bundling edits; as such, you may encounter some payers that will not allow separate payment for the stent insertion.

Finally, NCCI edits change quarterly.

This answer was correct at the time of publication, but you will need to make sure that edits do not change for future billings. Note: As we have stated many times before, documentation for all procedures should support the medical necessity for performing that procedure at that encounter. If medical necessity cannot be supported, the procedure should not be charged.

Addressing your second question, the description of 50760 (Ureteroureterostomy) does not include insertion of the stent. The two codes are bundled in the NCCI, but could be unbundled with the modifier. However, since the stent is being inserted because of the procedure and is related to the procedure, there is not a good modifier that will pull you out of the bundle. We would recommend that you not bill for the insertion of the stent separately.