AHA Coding Clinic® for HCPCS - 2026 Issue 2; Ask the Editor
Endoscopic Bladder Stone Removal Via Percutaneous Cystotomy
A patient presents with bladder stones greater than 2.5 cm and a retained left ureteral stent. A percutaneous cystolithotomy with left ureteroscopy, stone vacuum extraction, and ureteral stent removal are performed. The urethral meatus was intubated with a flexible cystoscope. Upon direct vision large bladder stones were noted. The left ureteral stent was grasped and brought to the meatus and the left wire that was passed up to the kidney was utilized to pass a flexible ureteroscope up to the kidney and a full pyeloscopy and ureteroscopy were performed. Small fragments remained and they were vacuum extracted with the scope.The patient was repositioned, and under ultrasound and cystoscopic guidance, an 18-gauge needle was placed into the bladder through a suprapubic approach. A 30 Fr incision was made, and a Nephromax 30 Fr dilator was used, and under visual guidance a 30 Fr sheath was placed. A 10 mm endo-catch bag was placed through the sheath, and the stones were placed inside. The bag was closed and secured. After the sheath was replaced into the bag, the Nephroscope was used with a rigid lithotripter to break up the massive hard stones, and all fragments were extracted along with the stent. At the conclusion of the procedure, a suprapubic catheter was placed and secured for drainage.When bladder stones are removed endoscopically by cystolitholapaxy via a percutaneous cystotomy, what is the appropriate CPT code(s) to report? Is an additional code reported to capture the percutaneous cystotomy? Or would an unlisted code be reported to capture the stone removal by endoscopic cystolitholapaxy via percutaneous cystotomy? ...
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