The correct coding for urinary catheter drainage from kidney requires knowledge about nephrostomy tubes and stents. When you use a nephrostomy drainage and catheter, some of the diagnosis indicating medical necessity for that procedure would be 591 hydronephrosis, 592.0 renal calculus, 592.1 ureteral calculus, 593.3 which would be angulation or stricture of the ureter, 593.4 other ureteric obstructions such as retroperitoneal fibrosis.
You would also use nephrostomy drainage for a congenital ureteral pelvic junction obstruction. The 753.21 and the 753.22 is a congenital urethral vesicle junction obstruction. Now, for drainage of the bladder, in other words, drainage with a urethral catheter or cystotomies, you may use this with diagnosis such as 596.0 bladder neck contracture, 596.4 bladder atony, 596.53 paralysis of the bladder, 596.54 neurogenic bladder, 600.01 would be BPH with obstruction and/or low urinary tract symptoms. The urinary retention codes may be appropriate, 788.20 and 788.21.
We also have codes that are appropriate such as 996.31. And this would be say, a mechanical complication of the urethral catheter or other GU catheter. 996.39 would be mechanical problems with a cystotomy tube. And then we have the code 939.0 which is a foreign body in the bladder and/or urethra. We see common ICD diagnosis for ureteral drainage procedures, 591 hydronephrosis, renal calculus, ureteral calculus, 593.3 ureteral stricture kinking or angulation, 593.4 say a ureteric obstruction secondary to idiopathic retroperitoneal fibrosis. Now, we have an interesting combination of codes, 591 as the primary and the secondary, V07.8. And this would explain the past - the performance of a drainage procedure for prophylaxis, 507.8, to avoid hydronephrosis, 591. And then we have the foreign body in a ureter and that code would be 939.9.
Coding for kidney Catheters and Tubes
Many years ago before we had percutaneous procedures, coders would code 50040 for a nephrostomy or nephrotomy with drainage. This was an open procedure placing a catheter through the kidney into the renal pelvis and then bringing it externally for drainage of the kidney. More recently however, most of these drainages of the kidney are performed percutaneously introducing an intracath or catheter in the renal pelvis for drainage and/or injection, again percutaneously. And you would use the code 50392 for the performance of a percutaneous nephrostomy.
Now, you may use radiological suppositions and that would be a standard radiological guidance with contrast material, 74475. You may do a percutaneous nephrostomy using ultrasound guidance, 76942, or even possible percutaneous nephrostomy using the CT scanner as your guidance, 77012. And we're going to look at some changes and removal of tubes. When you change a nephrostomy tube or a pyelostomy tube, in another word, taking out an old nephrostomy tube and replacing with a new one, use the code 50398.
We have a code 50389, which is the removal of a nephrostomy tube, requiring a fluoroscopic guidance. But that would be used when there is also a concurrent indwelling ureteral stent in place. You can use the fluoroscopy to make sure that when you remove the nephrostomy tube, you're not also removing the ureteral stent.
Now, when you remove a nephrostomy tube without fluoroscopic guidelines, just removing the tube without any procedure, you should - there is no CPT code for removal of a nephrostomy tube. And what you should do is bill that and that's included in the E/M service. For that simple removal of a nephrostomy tube, report the appropriate level of E/M service provided.
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