January 2016 Q & A

Question: 50435 and 50693

I have a doctor that did a left nephrostogram, ureteral stent insertion and a nephrostomy tube exchange at the same setting. With the new 2016 codes, there is no scenario with a pre existing nephrostomy tract tube exchange and a placement of ureteral stent. I am getting a CCI edit for 50435 saying it shouldn't be billed with 50693. Am I missing something, or misinterpreting something? Would you bill 50693, 50435-XU? Payer is Medicare.
Answer:
The placement of a ureteral stent via an existing access includes leaving in a PCN (percutaneous nephrostomy tube) if done.  So, the imaging and the PCN left in at the end of the procedure are bundled with 50693. ONLY submit 50693 with the procedure described. Do NOT submit 50435, as that is bundled with the new codes. Medicare is correct here!