What is the correct CPT (Current Procedural Terminology) code for a percutaneous pyelostolithotomy with dilation and basket extraction of a 1 cm stone?

Correct CPT Code for Percutaneous Pyelostolithotomy with Dilation and Basket Extraction of 1 cm Stone

The correct CPT code for a percutaneous pyelostolithotomy with dilation and basket extraction of a 1 cm stone is 50080.

Understanding CPT Code Selection for Percutaneous Nephrolithotomy

The selection of the appropriate CPT code for percutaneous stone removal depends primarily on the size of the stone being extracted. For this procedure, we need to consider the following codes:

• 50080: Percutaneous nephrostolithotomy or pyelostolithotomy, with or without dilation, endoscopy, lithotripsy, stenting, or basket extraction; up to 2 cm
• 50081: Same procedure but for stones over 2 cm
• 50040: Nephrostomy, nephrotomy with drainage (does not include stone removal)
• 50130: Pyelotomy with exploration (includes open surgical approach, not percutaneous)

Rationale for Code Selection

The key factors in this case are:

1. The procedure is percutaneous (minimally invasive)
2. It involves dilation and basket extraction
3. The stone size is 1 cm

Since the stone is 1 cm in size, which is less than 2 cm, the correct code is 50080. This code specifically covers percutaneous pyelostolithotomy with dilation and basket extraction for stones up to 2 cm in size.

Clinical Context

Percutaneous nephrolithotomy (PCNL) has become the standard procedure for large renal calculi, particularly those ≥2 cm. For stones in the 1 cm range, as in this case, percutaneous approaches offer several advantages:

• Minimally invasive with only a small (approximately 1 cm) skin incision
• Shorter hospital stays compared to open procedures
• Minimal postoperative morbidity
• High stone-free rates (85-95%) for appropriately selected cases

The American College of Radiology notes that PCN access has been shown to be useful for stone interventions, particularly when the stone burden is significant 1. The procedure typically involves creating percutaneous access to the kidney, dilating the tract, and then using endoscopic instruments to visualize and extract the stone.

Common Coding Pitfalls to Avoid

• Do not use 50081 unless the stone is larger than 2 cm
• Do not use 50040 as this code is for nephrostomy/nephrotomy with drainage but does not include stone removal
• Do not use 50130 as this is for open pyelotomy, not a percutaneous approach

Conclusion

Based on the procedure description (percutaneous pyelostolithotomy with dilation and basket extraction) and the stone size (1 cm), the correct CPT code is 50080.