Urology Coding Alert
Consider Gerota's Fascia Part of a Radical Nephrectomy
Question: When a urologist does a laparoscopic radical nephrectomy for renal cancer and removes Gerota’s fascia and the surrounding perinephric fatty tissue but does not remove the adrenal gland or regional lymph nodes, would the appropriate coding be 50545-52?
California Subscriber
Answer: No. You should not report 50545 (Laparoscopy, surgical; radical nephrectomy [includes removal of Gerota’s fascia and surrounding fatty tissue, removal of regional lymph nodes, and adrenalectomy]) with modifier 52 (Reduced services) attached for the procedure you describe.
Here’s why: Whenever the urologist removes Gerota’s fascia and the peri-nephric fat along with the removal of the kidney, this constitutes a radical nephrectomy. Although CPT® indicates that the adrenal gland and a regional node resection are also required, this represents an older outdated definition of a radial nephrectomy.
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