Urology Coding Alert

Question: The urologist performed a laparoscopic mobilization of a kidney but then did an open pyeloplasty. How should I report this converted procedure?

Answer: For most payers you should report the code for the open procedure alone because your urologist converted from a laparoscopic surgery to an open procedure. In your case, report 50400 (Pyeloplasty [Foley Y-pyeloplasty], plastic operation on renal pelvis, with or without plastic operation on ureter, nephropexy, nephrostomy, pyelostomy, or ureteral splinting; simple). Your diagnosis codes would include 753.21 (Congenital obstruction of ureteropelvic junction) and V64.41 (Laparoscopic surgical procedure converted to open procedure).

Alternative: A few private or commercial payers may reimburse you for both procedures " the open and the laparoscopic. In those cases, code the case as follows:

50400 for the open pyeloplasty

50544 (Laparoscopy ,surgical, pyeloplasty) for the laparoscopic kidney mobilization

Append modifier 52 (Reduced services) to 50544 since your urologist didn't complete the procedure

Append modifier 59 (Distinct procedural service) to 50544 to break the bundle between 50400 and 50544.