Reader Question:
Laparoscopic Nephrectomy
Published on Sat Dec 01, 2001
Question: How should I code a bilateral hand-assisted laparoscopic nephrectomy? The patient is an ESRD, 27-year-old woman with malignant hypertension who has received one kidney. She had both removed due to damage and was put on dialysis until her condition improved enough for her to go back on the transplant list.
New Jersey Subscriber
Answer: In the February 2001 issue of Urology Coding Alert, coding for hand-assisted laparoscopy (HAL) and nephrectomies (50545-50548) was discussed. The issue of bilateral nephrectomies performed by HAL was not discussed because it seemed such a rare circumstance. Medicare does not allow modifier -50 (bilateral procedure) on 50546 (laparoscopy, surgical; nephrectomy, including partial ureterectomy) and 50548 (... nephrectomy with total ureterectomy).
Bilateral billing is allowed for 50545 (radical nephrectomy [includes removal of Gerotas fascia and surrounding fatty tissue, removal of regional lymph nodes, and adrenalectomy]) and 50547 ( donor nephrectomy from living donor [excluding preparation and maintenance of allograft]).
If the former procedures are performed bilaterally, the physician should be paid for the work done. Here are several solutions:
1. File 50546 with modifier -99 (multiple modifiers) appended. Then, in block 19 of the claim form, write 99 = -LT, -RT, -51. This indicates that the procedure was performed on both sides, and the second would be paid as a multiple procedure.
2. File on two lines: 50546-LT and 50546-RT-51.
3. File on one line: 50546-50 (you will need to file the operative report and notes).