Urology Coding Alert
Kidney Transplant
Question: When performing a kidney transplant, can the physician charge for kidney preparation and graft preparation in addition to the donor nephrectomy code?
Oregon Subscriber
Answer: Donor nephrectomy from a cadaver donor (50300, Donor nephrectomy, with preparation and maintenance of allograft, from cadaver donor, unilateral or bilateral) includes preparation, flushing, and some type of preservation of the kidney before transplantation, often performed at another time. For this procedure, the kidney is removed and saved. From a live donor, 50320 (Donor nephrectomy, open from living donor [excluding preparation and maintenance of allograft]) or 50547 (Laparoscopy, surgical; donor nephrectomy from living donor [excluding preparation and maintenance of allograft]) does not include the flushing because the kidneys are transplanted in an adjoining operating room.
If, however, the procedures include significant effort and time for flushing and graft preservation, you should indicate the extra work by appending modifier -22 (Unusual procedural services) to 50320 or 50547. Supporting documentation must be sent with a paper claim for a mandated medical review.
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