Urology Coding Alert

Question: What is the difference between a laparoscopic simple nephrectomy (50546) and a radical nephrectomy (50545)?


Maine Subscriber

Answer: A laparoscopic radical nephrectomy includes removing the kidney, Gerota's fascia, and the adrenal gland, and performing a localized lymphaden-ectomy. In a simple nephrectomy, the urologist leaves the perirenal fascia and the adrenal gland, and does not perform a lymphadenectomy.

When your urologist performs a laparoscopic simple nephrectomy, report 50546 (Laparoscopy, surgical; nephrectomy, including partial ureterectomy).
 
You should report 50545 (Laparoscopy, surgical; radical nephrectomy [includes removal of Gerota's fascia and surrounding fatty tissue, removal of regional lymph nodes, and adrenalectomy]) when your physician performs a laparoscopic radical nephrectomy.

Caution: Often the urologist will elect to do a laparoscopic radical nephrectomy, removing the kidney and surrounding fascia but leaving the adrenal gland. Under these circumstances, the physician has still performed a radical nephrectomy.

To report this procedure, use 50545 but attach modifier 52 (Reduced services) to indicate your urologist did not complete all of the elements of the procedure. The insurance carrier may ignore the modifier and pay the full fee, decrease the fee by 10 to 20 percent, or request further documentation before issuing a payment.

Hint: The diagnosis may be a clue in the right direction. Typically, urologists perform radical procedures for malignancy, while simple procedures are for other diseases.