Urology Coding Alert

Question: How do physicians bill for a hand-assisted laparoscopic nephrectomy?

Connecticut Subscriber

Answer: This is a new procedure, developed because having the hand help with dissection quickens the surgery. For the urologist who is used to having his or her hand in the wound, there is a greater comfort factor than a straight laparoscopy, in which there is no hand in the wound. This could be coded two ways. One is 50546 (laparoscopy, surgical; nephrectomy) with modifier -22 (unusual procedural services) appended. Modifier -22 allows the physician to bill at a greater rate than 50546 unmodified. The alternative is 50230 (nephrectomy, including partial ureterectomy, any approach including rib resection; radical, with regional lymphadenectomy and/or vena caval thrombectomy) with modifier -52 (reduced services). Why the move toward laparoscopic surgery in urology, especially if urologists are more comfortable with open procedures? Partly because technology allows it, and partly because it shortens the hospital stay for some patients.