Q & A with Dr. David Zielske
 

Question: Changing a NUS to a PCN

Hello - there seems to be some confusion on how to code when a nephroureteral stent (NUS) is exchanged to a percutaneous nephrostomy (PCN). Can you please tell me what is appropriate to code for a NUS to PCN exchange? Do we code for a PCN exchange 50398/75984 or do we code for a PCN placement 50392/74475 with modifier -52 appended?

Answer

We recommend a percutaneous nephrostomy tube change with 50398 and 75984. To perform this procedure, you place a wire in the existing nephrostomy catheter, pull the catheter out, and place a nephrostomy tube over the wire.  There is not the work and risk involved that there is with creating the access that is involved with a de-novo placement.