Urology Coding Alert

Question: My doctor performed a robot-assisted nephrectomy that converted to an open procedure. He removed a kidney, the adrenal gland, and a tumor from the renal vein. He did not remove any lymph nodes. Is 50230 the correct code to use?

Nebraska Subscriber

Answer: For a robot-assisted nephrectomy converted to an open procedure per CPT^® rules and guidelines only submit the code for the open procedure by which the final results were achieved. Your best option is 50230 (Nephrectomy, including partial ureterectomy, any open approach including rib resection; radical, with regional lymphadenectomy and/or vena caval thrombectomy).

Take note: Although the urologist left the lymph nodes intact, 50230 is still appropriate despite the verbiage “… with regional lymphadenectomy and/or vena caval thrombectomy” in the descriptor. That phrasing means the code can be used in four ways:  

1. When a “regional lymphadenectomy” is performed; or
2. When a “vena caval thrombectomy” is performed; or
3. When both a “regional lymphadenectomy” and a “vena caval thrombectomy” are both performed; or
4. When the adrenal gland is also removed at the time of the nephrectomy.