# Nephrectomy help



## umcanes4 (Jul 29, 2016)

Hi everyone. Was wondering if someone can help guide me in the right direction. I am getting a few codes from other coders on this and I don't really know which way to go.  Thanks for your help in advance 

_Procedure Name:
Elective right radical nephrectomy.

Procedure Description:
After informed consent was received patient was brought to the operating room and placed in a flank position. His flank abdomen was preped and draped in a standard fashion.  A *right flank incision was made.  The muscle and fascia were appropriately divided. The retroperitoneum was entered.  The Bookwalter retractor was positioned in place.  The kidney was visible in the retroperitoneum.  The tumor and gerotas did appear to have a significant fibrotic reaction.  The tumor was hemorrhagic and friable. The cystic area did burst during our manipulation. Again there was alot of reaction around the gerotas and capsule which required meticulous dissection. We gently dissected our way around the kidney and towards the hilum using blunt dissection, ligasure, and vascular stapler.

We isolated the hilum.  A stapler was fired through the hilum thus dividing it. The upper pole was meticulously dissected without the adrenal gland using the stapler.  The kidney was then removed intact within the gerotas fascia.  We irrigated the space.  _

Did he remove only the Kidney and the gerotas fascia? When he says removed intact with the GF, that is what I am thinking. Maybe I am way off and wrong. 

I have one coder telling me to look at 50240 and another 50220. 

Thanks again!!!!
50240 only removes a portion of the kidney and 50220 removes the kidney, upper portion of ureter but no gerotas fascia.


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## emcee101 (Jul 29, 2016)

The long, lay description for CPT code 50220 (according to EncoderPro for Payers) states _ "The physician removes the kidney and upper ureter, but does not remove the adrenal gland, surrounding fatty tissue, or Gerota's fascia."_. since your physician removed the kidney "intact within the gerotas fascia" then he has performed more work than required for 50220 to be billed. Since 50220 is a more inclusive code than 50240 (partial nephrectomy) I would definitely NOT bill 50240. Of the choices left for  nephrectomy codes after removing 50240, 50220 would be your best option by far. I would bill this without reservation.

Just a suggestion, but I would encourage your provider to document a more detailed op note. I have never read an op note for an open nephrectomy that is this short and lacking in specific detail (anatomical landmarks, types of sutures used, length of incision, etc.) and I have coded urology for over 6 years for several different physicians. I would recommend to your physician that he document with more exact detail, which will help you as a coder and could also help him when, God forbid, he finds himself in a malpractice case and only has a few lines documented for a complex surgical procedure. 

Just my 2 cents, no offense intended.  

-Matt


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## umcanes4 (Jul 29, 2016)

Matt,

I agree with you 100% on the documentation. I have let them know re: their documentation even on the EM levels, which I just downcode because there is nothing else I can do for them. I have advised our dept. that provides education for the physicians and after that I give up. I try to tell them but they do what they want 

Thank you so much for your help.


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