Basics about 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.

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CPT code for Nephroureteral stent Exchange 50387

CPT code for Nephroureteral stent

The physician first inserts a long and thin needle into the back skin and then advances the needle toward the renal pelvis. Then the needle in advanced into the ureter. When the needle along with catheter reaches the ureter, the physician advances the stent over the needle. Once the stent is placed, the physician removes the needle. Now, the stent can be used for drainage and/or injection. The CPT code 50393 is used for Placing of nephroureteral stent. This CPT code is used only when the stent is placed into the ureter.

50393 Introduction of ureteral catheter or stent into ureter through renal pelvis for drainage and/or injection, percutaneous

The radiologist present interprets the exam. For supervision and interpretation we have separate CPT codes. CPT code 74480 is used for S&I when nephroureter stent is place.

CPT code for Nephroureteral stent Exchange

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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 50393 & 50387

Do code S&I 74480 or the Guidance CPT codes 76942, 77002, 77012 along with 50393. This procedure has to be done under the presence of radiologist or under any of these guidance.

Moderate conscious sedation should be coded separately with 50393 and 50387. Conscious sedation is not included in both Procedure codes.

Do not code 50393 for nephrostomy tube or catheter placement; we have to code 50392 for intracatheter or nephrostomy tube placement.

Do use 50 modifier when the Nephroureter stent is placed on both sides with CPT code 50393.

Do not code fluoroscopic guidance separately with 50387; it is included with CPT code 50387.

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.