Urology Coding Alert

Question: I coded a hand-assisted laparoscopic cryoablation of a renal mass lesion with intraoperative ultrasound as CPT 50542 with 223.0. Our Medicare carrier denied the claim stating it has a policy on this code, and I did not have a payable diagnosis. What am I doing wrong?

Iowa Subscriber

Answer: The reason you are receiving a denial is probably the diagnosis code you used: 223.0 (Benign neoplasm of kidney and other urinary organs; kidney, except pelvis). For a laparoscopic cryoablation of a kidney lesion (50542, Laparoscopy, surgical; ablation of renal mass lesions[s]), payers typically require a malignant kidney tumor diagnosis (189.0, Malignant neoplasm of kidney and other and unspecified urinary organs; kidney, except pelvis).

Usually, the final diagnosis will be carcinoma of the kidney although there will be no specimen to evaluate. Even without a specimen you can still report 189.0 as the diagnosis if your urologist preoperatively suspects a malignant kidney tumor. Using 189.0 will provide the payer with either medical necessity or enough reason for the ablation.

The presence or absence of a pathology report should not change your procedure coding or the perceived medical necessity for the procedure.

Caveat: Never report a diagnosis code just to get paid. If your urologist did not document a covered diagnosis, then you likely won't see payment. Talk with your physician to make sure he documents the exact diagnosis that's prompting him to perform a procedure.