Urology Coding Alert

Question: Our surgeon performed a hand-assisted laparoscopic radical nephrectomy and finished with an open distal completion ureterectomy. Should I code this as an open radical nephrectomy? Do I need to append modifier -22 (Unusual procedural services)?

Pennsylvania Subscriber Answer: It sounds as if your urologist performed a total nephroureterectomy via a laparoscopic and open procedure. If so, code this procedure as 50548 (Laparoscopy, surgical; nephrectomy with total ureterectomy) for the laparoscopic portion of the procedure, and 50650-51 (Ureterectomy, with bladder cuff [separate procedure]; multiple procedures) for the open distal ureterectomy and removal of a bladder cuff (if performed).

If he also did an adrenalectomy in this particular case, use 60650-51 (Laparoscopy, surgical, with adrenalectomy, partial or complete, or exploration of adrenal gland with or without biopsy, transabdominal, lumbar or dorsal; multiple procedures), because it is not included in the above laparoscopic nephrectomy.