Urology Coding Alert

Question: The surgeon did a partial nephrectomy, and the day after, it was discovered the kidney was unsalvageable and a total nephrectomy was performed. Are both procedures billable?

Minnesota Subscriber

Answer: Yes, you can report both procedures, but you will need a modifier on the second. 

Here’s why: The second surgery is to correct a postoperative complication of an initial procedure (the partial nephrectomy).

First, you will report the partial nephrectomy on the first date of service using 50240 (Nephrectomy, partial). Then, report the total nephrectomy on the second date of service using 50220 (Nephrectomy, including partial ureterectomy, any open approach including rib resection). 

Remember: Attach modifier 78 (Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period) to 50220. This indicates the procedure took place within the global period and, while it is related to the other surgery, this really represents a complication of the first surgery and your urologist did not prospectively plan to do a total nephrectomy.