Urology Coding Alert
Prepare to Justify Unlisted Thrombectomy Coding
Question: My doctor did a hand-assisted laparoscopic radical nephrectomy with vena cava thrombectomy, exploratory laparotomy, and lysis of adhesions. I'm pretty sure the exploratory nephrectomy and lysis of adhesions are going to be bundled into 50545, but I'm unable to find a code for a laparoscopic vena cava thrombectomy. What is the proper way to code this procedure? South Carolina Subscriber Answer: First, report 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 and the localized node resection. Then, use 37799 (Unlisted procedure, vascular surgery) to report the the laparoscopic vena caval thrombectomy. Payers will include the lysis of adhesions and the laparoscopic exploratory examination bundled into code 50545. Remember: There is no specific code at the present time for a laparoscopic venal caval thrombectomy, so you're forced to use the unlisted code. You will therefore need to provide full documentation within the operative report when the carrier requests it. You should also include a covering letter explaining what the urologist did and why. Benchmark the laparoscopic procedures with code 50230 (Nephrectomy, including partial ureterectomy, any open approach including rib resection; radical, with regional lymphadenectomy and/or vena caval thrombectomy) and the vena caval thrombectomy with open code 34401 (Thrombectomy, direct or with catheter; vena cava, iliac vein, by abdominal incision).
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