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Urology Coding Alert

Reader Question:

Choose One Code for Nephrectomy and Transplant

Published on Wed Oct 10, 2007

Question: My physician had to do a bilateral nephrectomy because both kidneys were bad, and in the same session he performed a kidney transplant. I was looking at my CCI list, and it does not allow billing the nephrectomies with the transplant. Can I bill these together, or will the nephrectomies get denied?

Ohio Subscriber

Answer: For this bilateral nephrectomy and renal transplant patient, you should report 50365 (Renal allotransplantation, implantation of graft; with recipient nephrectomy). Append modifier 50 (Bilateral procedure) to show that your physician removed both kidneys during the same operative session.

Code 50365 clearly states that this procedure includes a nephrectomy, so you should not report a separate nephrectomy code. Modifier 50 will indicate to the carrier that your physician deserves additional payment because he removed both kidneys.

The 2007 Physician Fee Schedule database, which is on the CMS Web site at www.cms.hhs.gov/PFSlookup, lists 50365 with a "1" in column T (labeled "BILAT SURG"), which means you can append modifier 50 to the code. A "1" indicator means the payer will reimburse you 150 percent for bilateral procedures -- 100 percent for the first side and 50 percent for the second.

Note: Using modifier 50 with 50365 relates to the nephrectomy part of this code, not a bilateral transplant, which the urologist did not perform. At the same time, 50360 (Renal allotransplant ... without recipient nephrectomy) does not accept or allow modifier 50.

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