Urology Coding Alert

Question: Our physician performed a partial laparoscopic nephrectomy in the morning. She was called back to the hospital later that night due to renal bleeding and performed a radical laparoscopic nephrectomy. In most circumstances I would assume the XE modifier would be appropriate since she returned and completed a second procedure at a separate time. However, I am not certain whether this is correct. Would the XE modifier on the second surgery be acceptable, or are we allowed to only bill the radical procedure?

Mississippi Subscriber

Answer: Selection of the correct CPT^® code(s) depends on the surgeon’s documentation. If you have clear documentation of medical necessity for each case, you can bill both surgical codes:

• 50543 (Laparoscopy, surgical; partial nephrectomy) for the first procedure
• 50545 (Laparoscopy, surgical; radical nephrectomy [includes removal of Gerota’s fascia and surrounding fatty tissue, removal of regional lymph nodes, and adrenalectomy]) for the second surgery.

In coding for the two laparoscopic kidney procedures, you will find that 50543 has higher relative value units (RVUs) and pays more than 50545. However, 50543 is bundled into code 50545. Therefore, in billing for the above clinical scenario you will need to append a modifier to 50543 to explain to the insurer why you are reporting both a partial and radical nephrectomy on the same date of service.

Depending on the payer’s guidelines, you should append modifier 78 (Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period) to care surgically for a complication arising from the first surgical procedure.