The focus of “Spotlight on CPT” this month is the coding for percutaneous nephrolithotomy procedures. These codes underwent revision in 2023 so it is a good time for a review.
Percutaneous nephrolithotomy procedures are minimally invasive procedures performed to remove kidney stones. Usually, these procedures are done when the kidney stones are:
- Large (> 2 cm)
- Blocking more than one branch of the collecting system
- In the ureter
Since the procedure is percutaneous, it means that the access is through the skin of the back, and then a small tube is navigated to the kidney where the stones are then removed.
The codes for percutaneous nephrolithotomy are inclusive of several procedures. Treatment of stones with lithotripsy and/or extraction are part of the codes. A ureteroscopy that is done in an antegrade manner would also be part of the code if performed, as would the placement of a nephrostomy tube.
There are two codes, 50080 and 50081 which are defined below, that may be assigned for percutaneous nephrolithotomy procedures. The codes distinguish between a simple procedure which is one where stones that are up to 2 cm in single location of the kidney or pelvis are treated, or a complex procedure where treatment is done for stones that are greater than 2 cm, stones that branch, stones in multiple locations, ureteral stones, or when there is complicated anatomy. These codes are considered unilateral.
50080 Percutaneous nephrolithotomy or pyelolithotomy,
lithotripsy, stone extraction, antegrade
ureteroscopy, antegrade stent placement and nephrostomy tube placement, when performed,
including imaging guidance, simple (eg, stone(s) up to 2 cm in
single location
of kidney or
pelvis, nonbranching stones)
50081 complex (eg, stone(s) > 2 cm,
branching stones, stones in multiple locations, ureter
stones,
complicated anatomy)
The picture below shows a percutaneous nephrolithotomy with lithotripsy of a large kidney stone. Close observation shows two other stones in the kidney. Assuming those stones are also treated, the code assignment for this procedure would be 50081.
The next picture shows a staghorn calculus which is a branching kidney stone. The branches can block urine from leaving the kidney which can lead to infection and/or kidney failure.
Now, light has been shed on percutaneous nephrolithotomy procedures.
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About the Author
Dianna Foley, RHIA, CCS, CHPS, CDIP, is
OHIMA's Education Coordinator. Dianna has been an HIM
professional for over 20 years. She progressed through the ranks of coder,
department supervisor, and department director, to her current role as a
coding consultant. She previously served as the program director for Medical Coding and HIT at Eastern Gateway Community College. Dianna earned her bachelor's degree from the University of Cincinnati and holds RHIA, CHPS, CDIP and CCS certifications. She is an AHIMA Approved ICD-10-CM/PCS Trainer and is a presenter on coding topics at the national, state, and regional levels. Dianna mentors new AHIMA members and also provides monthly educational lectures to coders and clinical documentation specialists.
