Urology Coding Alert
Multiple Incisions Can Still Mean a Single Code
Question: One of our providers performed what he termed a “hand assisted laparoscopic nephroureterectomy.” He performed a laparoscopic nephrectomy and retroperitoneal/abdominal ureterectomy, and removed these organs through the hand assisted incision. He then performed a cystoscopic examination and a hot knife dissection and removal of the ureteral orifice, a cuff of bladder, and the intramural ureter to complete the total ureterectomy and removal of a cuff of bladder which were then removed endoscopically.
We have always billed 50548 when both the kidney and ureter are removed. But because he used the cysto this time, would we bill 50545 and bill the cysto with the removal of the ureter separately? We are thinking of using 50949 for an unlisted code for that. What do you advise?
Michigan Subscriber
Answer: A provider can use any type of endoscope to perform the procedure you describe, and can also use other instruments or an additional light source through other incisions during laparoscopic procedures. Because of this, you need to report 50548 (Laparoscopy, surgical; nephrectomy with total ureterectomy) for the removal of the kidney and retroperitoneal/abdominal ureter and 52214 (Cystourethroscopy, with fulguration [including cryosurgery or laser surgery] of trigone, bladder neck, prostatic fossa, urethra, or periurethral glands) for the endoscopic removal of the intramural ureter, the cuff of bladder, and the ureteral orifice.
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