Urology Coding Alert

Question: My urologist performed a left nephrectomy, excision of fistulous tract, and lysis of adhesions of the colon and stomach. I am not sure if I can code the excision of the fistulous tract. If I can, which code is appropriate?

Ohio Subscriber

Answer: The coding for this scenario depends on whether the nephrectomy was complicated because of previous surgery or infection, which may be the possible cause for the fistula. If the urologist's operative report suggests this is the case, report 50225 (Nephrectomy, including partial ureterectomy, any open approach including rib resection; complicated because of previous surgery on same kidney) for the complicated nephrectomy.

Alternative: If the urologist says the nephrectomy was not complicated by previous surgery or infection, you should report 50220 (Nephrectomy, including partial ureterectomy, any open approach including rib resection) for the nephrectomy. Append modifier 22 (Increased procedural services) if the nephrectomy was prolonged and more difficult because of the adhesions.

Then report 11042 (Debridement; skin, and subcu-taneous tissue) or 11043 (Debridement; skin, subcu-taneous tissue, and muscle) for the excision of the fistula depending on the depth of the fistula removal.

Attach modifier 51 (Multiple procedures) to the debridement code to specify that your urologist per-formed separate procedures on the same patient at the same session.