Urology Coding Alert

Question: My urologist saw a Medicare patient with transitional cell carcinoma of his left ureter. The physician cystoscopically excised the left ureteral orifice and fulgurated the surrounding area to allow the ureter to migrate into the retroperitoneum. Then the patient was repositioned and the urologist opened in the midline inferior to the umbilicus into the peritoneal cavity. He placed trocars at 10 and 20 cm lateral to the main incision using his left hand inside the wound to make sure that no injury to the bowel occurred. He then laparoscopically removed the kidney and ureter. How should I code this procedure?

Indiana Subscriber

Answer: First, report 50548 (Laparoscopy, surgical; nephrectomy with total ureterectomy) for the laparoscopic total nephroureterectomy. Since your urologist removed both the kidney and the ureter via laparoscopic approach, 50548 is the appropriate code. Next, report 52214 (Cystourethroscopy, with fulguration [including cryosurgery or laser surgery] of trigone, bladder neck, prostatic fossa, urethra, or periurethral glands) for the fulguration, excision, and freeing up of the intravesical ureter. Append modifier 51 (Multiple procedures) -- if your payer requires you use this modifier -- to show the payer that your urologist performed more than one procedure during the same session.

Keep in mind: Modifier 51 is an informationaltype modifier for use on the second, third, etc., surgical procedure performed on the same day as anotherprocedure you are reporting. Many payers, including Medicare, no longer require modifier 51. Processing claims electronically allows the payer to recognize when your physician performs multiple procedures, and automatically make the any necessary reductions in payment.