Urology Coding Alert

Question: My urologist performed a laparoscopic nephroureterectomy and excision of the distal ureter and bladder cuff with an open second incision. I want to code it with 50548, but I am stumped on the second incision part of the surgery. What is the proper coding?

Vermont Subscriber

Answer: Report 50548 (Laparoscopy, surgical; nephrectomy with total ureterectomy) for the laparoscopic nephroureterectomy, as you suggested. Then, you should also report 50650 (Ureterectomy, with bladder cuff [separate procedure]) for the open pelvic procedure with removal of the most distal ureter and a cuff of bladder.

Don't forget: Append modifier 59 (Distinct procedural service) to 50650 to break the bundle that exists between these codes. You can break this Correct Coding Initiative (CCI) bundle since this latter procedure is an open lower abdominal procedure on the same side but is a separate and distinct operation involving another part of the urinary tract and a separate/different incision.