Urology Coding Alert

Now that you’ve studied the situations on page ___, here’s how you should report each one.

Scenario 1 answer:  Bill only for the laparoscopic radical nephrectomy. Submit the following single CPT® code:

• 50545 (Laparoscopy, surgical; radical nephrectomy [includes removal of Gerota’s fascia and surrounding fatty tissue, removal of regional lymph nodes, and adrenalectomy]).

Although the initial procedure was planned to be a partial laparoscopic nephrectomy, a partial nephrectomy was not performed or completed, points out Michael A. Ferragamo MD, FACS, assistant clinical professor of urology with the State University of New York, University Hospital and Medical School at Stony Brook. The choice to perform a laparoscopic radical nephrectomy was made intraoperatively during the dissection when the tumor was found to be more extensive than originally thought. Billing for both nephrectomies for this clinical scenario at the same encounter would be inappropriate coding.

Scenario 2 answer: Report only 50230 (Nephrectomy, including partial ureterectomy, any open approach including rib resection; radical, with regional lymphadenectomy and/or vena caval thrombectomy) for the radical nephrectomy. By definition, you should not use the renal exploration code 50010 (Renal exploration, not necessitating other specific procedures) under these circumstances. When a physician performs a nephrectomy, a renal exploration is an integral part of the procedure and as such should not generate a separate charge.

Scenario 3 answer: Since both a partial nephrectomy was performed and completed during one part of the operation and then a radical nephrectomy was performed at the same encounter because of reported positive » margins, you can code for both the partial and complete nephrectomies, and expect to be reimbursed for both. Submit 50240 (Nephrectomy, partial) and 50230 (Nephrectomy, including partial ureterectomy, any open approach including rib resection; radical, with regional lymphadenectomy and/or vena caval thrombectomy) with modifier 51 (Multiple procedures).

“Modifier 51 is a modifier used to report multiple procedures—in other words, when a patient has had more than one surgery on the same day and Medicare allows for separate payment,” Angela James of CMS reminded in a recent “CMS Provider Minute” presentation.

For many non-Medicare payers, appending modifier 51 notifies the payer that the urologist performed two procedures that are not bundled during a single surgical encounter in the same area of the body, and that they should be separately reimbursed. For Medicare patients, however, you do not need to append modifier 51; Medicare will append it for you.