A patient with a history of kidney stones and a ureteral stent presents for a right percutaneous nephrolithotomy (PCNL) and cystoscopy with ureteral stent insertion. A flexible cystoscopy was performed and the existing ureteral stent was removed. An access sheath was placed into the ureter under direct cystoscopic supervision.
Next, the flexible ureteroscope was placed into the access sheath and the stones were visualized in the collecting system. Some ureteral stones required retrograde ureteroscopy with stone basketing. Under fluoroscopic guidance, a diamond tip needle was used to obtain renal access and the wire was passed into the collecting system and left in place. Stab incision was made into the flank and the access site was dilated under fluoroscopy with a balloon. The renal stone, encompassing the entire lower pole system, measured greater than 2 cm, and was fragmented and vacuumed with the lithotripter. Additional upper pole stones were removed via ureteroscopy with stone basketing and grasped with the nephroscope.
After stone evacuation was complete, access was created for placement of an indwelling ureteral stent with cystoscopic guidance. Is it appropriate to report a percutaneous nephrolithotomy which includes stent placement with cystoscopic insertion of ureteral stents with CPT codes 50080-81 and 52332? Or is the placement of the ureteral stent included in CPT code(s) 50080-81 and not separately reported?
Assign CPT codes 50081, Percutaneous nephrostolithotomy or pyelostolithotomy, with or without dilation, endoscopy, lithotripsy, stenting, or basket extraction; over 2 cm, for the PCNL with removal of a stone greater than 2 cm. In addition, assign CPT code 52332, Cystourethroscopy, with insertion of indwelling ureteral stent (eg, Gibbons or double-J type), to capture the retrograde insertion of a ureteral stent via cystoscope.
Although CPT code 50081 includes stenting, in this case a ureteral stent was placed retrograde fashion via a cystoscope supporting the additional assignment of CPT code 52332.