# radical vs partial nephrectomy; mets dx



## PedSurgery (Feb 3, 2015)

Hello, 
I need help-2 different specialty docs, general surgeon[his pt] and uro surgeon.  

The kidney was inspected carefully, and the tumor mass appeared to be replacing the superior and lateral portions of the kidney. It was not possible to isolate a segmental vascular supply to the remaining renal tissue. Additionally, isolating and repairing the collecting system to any remaining renal tissue would not be safely possible, as there would remains a significant risk of a urine leak. Therefore, we decided to proceed with radical nephrectomy. The renal artery was then identified and isolated. It was then doubly ligated proximally and singly ligated distally with ties of 3-0 Vicryl. The artery was then divided. The renal vein was ligated and divided in a similar manner. Remaining retroperitoneal attachments were then divided and the kidney mobilized fully. The adrenal gland remained adherent to the kidney, and dense adhesions between the adrenal gland and under surface of the liver and inferior vena cava were divided carefully using sharp and electrocautery dissection. A small piece of densely scarred adrenal remained in situ.

The ureter was then dissected down into the pelvis where it was ligated with 2 independent ties of 3-0 Vicryl. The kidney and tumor were then submitted as a specimen. The tumor bed was irrigated and there was no evidence of bleeding. There were small, soft, shotty nodes noted in the mesentery, but no firm or enlarged nodes noted in the tumor bed, nor in the pericaval or periaortic areas.  No other gross abnormalities were identified.
50230 
50230-52 
OR
50240
thanks for your help


----------



## emcee101 (Feb 9, 2015)

There is no question that a partial nephrectomy, 50240, is the incorrect code choice since they clearly removed the entire kidney and adrenal gland. The decision now is between a simple 50220 and radical 50230 nephrectomy. 

The difference as noted in the CPT codes is "with regional lymphadenectomy and/or vena caval thrombectomy" noted in thedescription of the radical CPT code and not in the simple code description. Neither of these were noted in the op report you provided, but the provider clearly documented that a radical was being performed. I would not bill 50220, and would in place submit 50230 with a 52 modifier to report the reduced services were perfomed with a radical nephrectomy. 

Of note: 50220 and 50230 cannot be billed together since they are reporeting the same base procedure, a nephrectomy, and CCI edits do not allow this. 

Regards


----------

