Question: What are the appropriate codes to report a percutaneous renal access for an antegrade pyelogram study?
Answer: Reporting a percutaneous antegrade pyelogram (nephrostogram) depends on whether a new access is required, or whether an existing access is in place. For a patient requiring a new access, the procedure is performed under imaging guidance by percutaneous placement of a needle or catheter into the renal pelvis under imaging guidance. Contrast medium is injected and a series of images are performed to observe the flow of contrast material as it passes from the renal collecting system through the urinary tract. This is appropriately reported with CPT® code 50430, Injection procedure for antegrade nephrostogram and/or ureterogram, complete diagnostic procedure including imaging guidance (eg, ultrasound and fluoroscopy) and all associated radiological supervision and interpretation; new access. Additionally, instructional guidelines in the CPT codebook under the Other Introduction (Injection/Change/Removal) Procedures states, “Code 50430 also includes accessing the collecting system and/or associated ureter with a needle and/or catheter.”
For a patient with an existing access, contrast medium is introduced through an existing tube, catheter, or stoma. This procedure is reported with CPT code 50431, Injection procedure for antegrade nephrostogram and/or ureterogram, complete diagnostic procedure including imaging guidance (eg, ultrasound and fluoroscopy) and all associated radiological supervision and interpretation; existing access. It is important to note that antegrade nephrostogram/ureterogram is included in all of the percutaneous genitourinary procedures (50432, 50433, 50434, 50435, 50693, 50694, 50695).