Genitourinary Procedures: Accessing 2019’s New Codes

CPT^® codes 50436 and 50437 were introduced this year for dilation of a new or existing tract for endourologic procedures. As with most bundled codes, 50436 and 50437 are very similar, but do have important differences, and are very inclusive.

What is this procedure?

A tract is created percutaneously (through the body wall) into the kidney to allow for passage of a device into the kidney and/or ureter. This would be done to create access, or enlarge an existing access, for endourologic procedures to be performed beyond this point (the dilated tract) such as kidney stone removal. The intent of these new codes is very clear and very specific – they are for endourologic procedures only.

Some key phrases in the documentation that can help identify this procedure include balloon dilator, serial dilator or sheath.

What’s similar between the codes?

There’s a number of similarities between the codes, including:

• Both describe access for subsequent endourologic procedures
• Both include a diagnostic ureterogram or nephrostogram
• Both include imaging guidance
• Both include radiological S&I services
• Both will be used to allow the GU tract to accommodate large-sized instruments for endourologic procedures
• Neither will be used for normal dilation of the tract for placement of a nephrostomy tube or nephroureteral catheter.

More importantly, what’s different?

Code 50436 is reported when there is an existing tract and that tract is enlarged to allow for use larger instruments during an endourologic procedure.

Code 50437 is reported instead of code 50436 when there is no existing tract and the radiologist must create a new access as well as dilate the tract for the surgeon.