Q&A: 2019 CPT codes for urinary surgery

Q: What new CPT codes for urinary procedures did the American Medical Association introduce for calendar year 2019?

A: The American Medical Association added three new codes to the CPT Manual. The association added two codes for renal introduction procedures:

• 50436, dilation of existing tract, percutaneous, for an endourologic procedure including imaging guidance (e.g., ultrasound or fluoroscopy) and all associated radiological supervision and interpretation, with post-procedure tube placement, when performed
• 50437, …; including new access into the renal collecting system

CPT code 50436 describes the dilation of a percutaneous renal tract to provide urine drainage or diversion from the kidney due to obstruction, leaks, or stones. During this procedure, a surgeon inserts a guide catheter into the tract under ultrasound or fluoroscopic guidance and advances it to the selected renal calyx and intrarenal collecting system. The surgeon then introduces serial dilators through the catheter until the desired diameter has been reached and withdraws the catheter.

New access into the renal collecting system may be necessary following percutaneous dilation of an existing tract. Under these circumstances, a surgeon places a percutaneous access needle through the skin of the back or flank and into the posterior renal calyces. He or she then passes a catheter or nephrostomy tube through the needle and into the renal calyx and intrarenal collecting system under ultrasound or fluoroscopic guidance then withdraws the needle. CPT code 50437 would be used to report this procedure.

Another new CPT code, 53854 (transurethral destruction of prostate tissue; by radiofrequency generated water vapor thermotherapy), was added to the CPT Manual for destruction of prostate tissue by radiofrequency generated water vapor thermotherapy.

Transurethral water vapor thermotherapy uses the thermal energy in steam to treat benign prostatic hyperplasia and its accompanying lower urinary tract symptoms. During this procedure, water vapor is delivered directly into the prostate tissue that’s causing the obstruction. The condensation releases enough thermal energy to necrotize the targeted prostate tissue cells.

Editor’s note: Peggy Blue, MPH, CCS, CCS-P, CPC, CEMC, partner at the American Regulatory Compliance Society, in Grand Haven, Missouri, answered this question during the HCPro webinar, “2019 CPT Update: Prepare for New Coding, Documentation Requirements.”

This answer was provided based on limited information. Be sure to review all documentation specific to your own individual scenario before determining appropriate code assignment.

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