Ob-Gyn Coding Alert

Question: I need help with this ureterolysis note. The physician (GYN Oncologist) is doing a TAH. He writes down the codes that he wants coded. He says:

“The retroperitoneal space was then opened and the ureters were identified. The left ureter was traced from the pelvic brim to bladder to remove the ovarian mass from the pelvic sidewall.”

The case after completion was then turned over to Dr XX for a partial nephrectomy.

Findings: Left ovarian mass-endometriosis and fibroma. Uterus with fibroids. Normal right ovary. Normal pelvis and upper abdomen.

Could you please give me a better description of code 50715? Or some helpful hints to recognize when this code should be used. To me this is not the correct use for this code. It reads to me as if he is moving around ureter to remove mass. Would be included in the TAH?

Possibly a modifier 22? But I don’t read any difficulty to necessitate a modifier 22. Am I looking at this wrong?

South Carolina Subscriber

Answer: Remember to look at the description of the code “for retroperitoneal fibrosis.” In other words, the code is diagnosis driven. In this case the physician followed the ureter to remove the mass, which is surgical access not ureterolysis.

Keep in mind that the CPT^® vignette for 50715 (Ureterolysis, with or without repositioning of ureter for retroperitoneal fibrosis) describes an open abdominal procedure, but one which requires that the patient have dense fibrotic tissue encasing the ureter(s). The surgery frees up the ureter from this encasing tissue to open it up and allow urine to pass through the ureter without constriction.

Using modifier 22 (Increased procedural service) is possible in this case, but the description of the work you have included is does not appear to show substantial additional work. It could be the ob-gyn removed the ovary with the mass and it just took longer to get to the ovary — but then time should be documented. Remember that 58150 (Total abdominal hysterectomy (corpus and cervix), with or without removal of tube[s], with or without removal of ovary[s]) includes removal of ovaries when performed.