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Nephrostomy tube removal: How to code

Consider modifier if procedure is performed with another service and requires extra effort


Q Is there a code for nephrostomy tube removal?


Ray Painter, MD
A The only code for nephrostomy tube removal is 50389 (Removal of nephrostomy tube, requiring fluoroscopic guidance [eg, with concurrent indwelling ureteral stent]). If this was the circumstance of your question, the above code is appropriate. Another possible answer to your question is code 50398 (Change of nephrostomy or pyelostomy tube) for a simple exchange of a nephrostomy tube. However, there is no code for a simple removal of a nephrostomy tube as your question implies.

As with other circumstances like this, if a nephrostomy tube removal is performed in conjunction with another service, such as an evaluation and management service, you should either report the other service(s) documented and consider the nephrostomy tube removal incidental or add a –22 to the other service if documentation supports a significant increase in effort (perhaps prolonged service codes with E&M codes). If the nephrostomy tube removal was the only service documented, you may wish to consider code 53899 (Unlisted procedure, urinary system).

Q My urologist has started ordering three antibodies on each prostatic needle biopsy we do. He was told that he could charge for all three antibodies on each core of tissue. Is this correct?


Mark Painter
A The most likely answer for the future is no. However, the answer today is likely yes, depending on how many tubes of specimens were sent to the pathologist for separate analysis and how many stains were used on each specimen. In addition, billing may be different for Medicare patients compared with private insurance patients.

The correct way to bill for the antibody stains on prostatic biopsy specimens is with CPT code 88342–Immunohistochemistry (including tissue immunoperoxidase), each antibody. This code, by definition, allows for the charge for each antibody checked for each specimen. A specimen is defined as a block of tissue to be separately identified. For prostatic needle biopsies, the number of specimens would be the number of tubes of tissue, not the actual number of biopsies taken unless each biopsy was placed in a different tube.

However, at the beginning of the year, the Correct Coding Initiative (CCI) introduction included a section specifically addressing code 88342. According to these rules, you can only charge one unit for each "stain," even if you're checking two or more antibodies with that single stain. Therefore, according to CCI, you would only be able to charge one unit for each specimen, if all three antibodies are checked with one stain. To complicate matters, billing requirements for code 88342 have been addressed by most carriers through an established local coverage decision (LCD). The LCDs differ by state and today differ from the rules in the CCI.

To specifically answer your question for Medicare, check your current LCD and watch your bulletin for proposed changes to the LCD. You will need to read the language of the LCD or bulletin to determine whether or not there is a per-stain and/or per-specimen restriction. In addition, carefully read the definition of a specimen in your LCD.

For private payers, depending on your contract, you should be able to continue to charge one unit for each antibody checked for each separate specimen. PRS has reached out to the American Medical Association to address the issue directly with CCI development personnel to encourage conformance with CPT verbiage. Stay alert.

Urologist Ray Painter, MD, is president of Physician Reimbursement Systems, Inc., in Denver and is also publisher of Urology Coding and Reimbursement Sourcebook. Mark Painter is CEO of PRS Urology SC in Denver.

Send coding and reimbursement questions to Ray Painter, MD, and Mark Painter c/o Urology Times, at
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Questions of general interest will be chosen for publication. The information in this column is designed to be authoritative, and every effort has been made to ensure its accuracy at the time it was written. However, readers are encouraged to check with their individual carrier or private payers for updates and to confirm that this information conforms to their specific rules.

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