Urology Coding Alert

Question: If during a radical nephrectomy there is no lymphadenectomy or vena caval thrombectomy, should we use CPT 50230 appended with modifier -52?

New Jersey Subscriber

Answer: The description of radical nephrectomy (50230, Nephrectomy, including partial ureterectomy, any open approach including rib resection; radical, with regional lymphadenectomy and/or vena caval thrombectomy) includes regional (localized nodes) lymphadenectomy and/or, if needed, vena caval thrombectomy. If a radical nephrectomy is performed with early ligation of the pedicle followed by removal of the kidney and its surrounding fascia (more than a simple nephrectomy [50220, Nephrectomy, including partial ureterectomy, any open approach including rib resection]) but there is no node resection or vena caval tumor thrombectomy, you should code the radical nephrectomy (50230) and append modifier -52 (Reduced services), as you suggest.

Because of the modifier, you should submit the claim manually with an explanation and the full operative report. Expect delayed payment.

Answers to You Be the Coder and Reader Questions contributed by Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology, State University of New York, Stony Brook; Sandy Page, CPC, CCS-P, co-owner, Medical Practice Support Services, Denver; and Morgan Hause, CCS, CCS-P, coding specialist, Urology of Indiana, Indianapolis.