Urology Coding Alert

Question: I’m coding for a case where a robotic partial nephrectomy was converted to a radical nephrectomy because the urologist found vein invasion intra-operatively and confirmed it with a frozen section. One of our coders says that the partial and radical nephrectomies are bundled together and cannot be billed separately since the case was laparoscopic instead of open. How do you suggest I bill this?

Washington Subscriber

Answer: You actually can report both approaches. Submit the following codes for this laparoscopic procedure:

• 50543 (Laparoscopy, surgical; partial nephrectomy) with modifier XU (Unusual non-overlapping service) appended for the initial partial nephrectomy
• 50545 (Laparoscopy, surgical; radical nephrectomy [includes removal of Gerota’s fascia and surrounding fatty tissue, removal of regional lymph nodes, and adrenalectomy]) for the radical nephrectomy.

Including the modifier XU with code 50543 breaks the CCI edit bundle and allows payment for both procedures as when the surgeon performs open procedures. This is a rare instance in which a bundled procedure/Column 2 code pays more than its associated Column 1 code. Because of this, it should be considered the first line procedure.