Urology Coding Alert

Question: My urologist started a laparoscopic nephrectomy that he had to convert to open. I'm having trouble coding it because the physician removed the patient's kidney and total ureter, but not the bladder cuff. Which code should I use?

Texas Subscriber

Answer: The first thing you need to keep in mind is that when a laparoscopic nephrectomy converts to an open procedure, for Medicare and most other carriers you should just report the open procedure code. In your scenario, you should report 50234 (Nephrectomy with total ureterectomy and bladder cuff; through same incision) if the urologist performed the procedure via one incision. If the physician used two incisions, you should report 50236 (... through separate incision).
 
Remember: Append modifier 52 (Reduced services) to whichever nephrectomy procedure code you report. This modifier indicates to the carrier that the urologist did not perform all of the procedure as described in the CPT definition of the procedure. In this case, since the urologist did not remove the bladder cuff, you'll need to use this modifier.

Tip: You'll also use V64.41 (Laparoscopic surgical procedure converted to open procedure) as a secondary diagnostic code to indicate that the surgery started as laparoscopic and the urologist had to convert to an open procedure.