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Urology Coding Alert

Reader Question:

Nephrectomy without Adrenal Gland Removal

Published on Fri Mar 01, 2002

Question: Should I bill 50230 for a radical nephrectomy even if the adrenal gland was not removed?

Maryland Subscriber  
Answer: Code 50230 (Nephrectomy, including partial ureterectomy, any open approach including rib resection; radical, with regional lymphadenectomy and/or vena caval thrombectomy) does not mention the adrenal gland, although it refers to a local node resection and/or vena caval thrombectomy. A radical nephrectomy is the removal of a kidney with surrounding fascia and an early ligation of blood supply. The standard of practice is not to remove every adrenal gland. If the tumor is small and confined to the lower pole of the kidney, and the adrenal appears unremarkable on palpation and visual inspection, many urologists leave the adrenal intact. Code 50230 is correct. There is no need to use 50220 (the base code for 50230).
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