Basics about CPT code 50387  Placement and Replacement of Nephroureteral stent

Nephroureteral stents including antegrade, retrograde, or internal (double-J) stents are routinely placed by interventional radiologists. The main reason for placing stent is to get clear picture about the indications or the symptoms. We have a separate cpt code for placement ureter stent in interventional radiology facility. CPT code for renal stent placement is used mostly for drainage or injection procedure. The physician usually places the stent through the skin (percutaneous) into ureter for drainage and injection. Also we have a separate procedure for the replacement of ureter stent. Let us checkout each of these procedure codes used for ureter stent placement. CPT code 50387 is used for replacement of Nephroureteral stent in medical coding.

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Description of CPT code 50432 and 50433 for Nephroureteral stent

The physician inserts a catheter through the skin and into the kidney for drainage of urine and/or for an injection. With the patient lying face down and the puncture site having been identified, a local anesthetic is injected. A needle with a guidewire is slowly advanced into the kidney under fluoroscopic guidance. The needle is removed when urine flows back through and, if necessary, the tract may be dilated to accommodate the catheter or nephrostomy tube, which is advanced over the needle, and the needle is removed. The catheter or nephrostomy tube is fixed in place and secured on the skin with a drainage bag attached. These codes include diagnostic nephrostogram and ureterogram, imaging guidance, and all radiological supervision and interpretation. CPT code 50433 is reported for placement of a nephroureteral catheter via a new access.

CPT code for Replacement of Nephroureteral stent

The physician removes the stent and replaces it with a new ureter stent. The whole procedure is done under fluoroscopic guidance. The contrast is sometimes injected through the catheter to check the final position of the stent. Once the old stent is removed, the new stent is placed over the guidewire under fluoroscopy. Fluoroscopy helps in assessing position of the ureter stent. Once the stent is placed correctly, guidewire is removed. The whole process should be taken through same access site. CPT code 50387 is used for both removal and replacement of ureter stent through same access.

50387  Removal and replacement of externally accessible transnephric ureteral stent (eg, external/internal stent) requiring fluoroscopic guidance, including radiological supervision and interpretation\

Do and Don’t for CPT code  50387

Guidance and imaging are bundled in codes 50433, 50434, 50387

Fluoroscopy is required for codes 50387 (exchange) and 50389 (removal)

Do not code a routine tube check in addition to the nephroureteral catheter change in the same ureter, as it is bundled into code 50387

If the nephrostomy or nephroureteral catheter is removed (without replacement) without use of fluoroscopy, use the appropriate E&M service code.

Removal without replacement of externally accessible ureteral stent without fluoroscopic guidance, report with appropriate evaluation and management service code.

Removal and replacement of ureteral stent through ureterostomy tube or ileal conduit, will be coded 50688.

CPT Code 50436 and 50437 include post procedure placement of a nephrostomy tube.

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Related CPT codes for Nephroureteral stent