Urology Coding Alert

Question: Can I bill a robotic/laparoscopic partial nephrectomy (50543) plus 50500? There is no trauma to the kidney, and there are no CCI edits between these two codes. I was told by another physician that the suture is part of the partial nephrectomy procedure and should not be billed.

North Carolina Subscriber

Answer: Code 50543 (Laparoscopy, surgical; partial nephrectomy) is a laparoscopic partial nephrectomy and 50500 (Nephrorrhaphy, suture of kidney wound or injury) is an open procedure suture of a kidney wound or laceration. You should not bill these codes at the same time or on the same day (same encounter) unless the suture laceration is to treat a complication of bleeding after the partial nephrectomy is completed, that is an open procedure is necessary to suture the bleeding kidney wound following conclusion of the laparoscopic partial nephrectomy.

Suturing of the kidney is part of the laparoscopic partial nephrectomy and is not a separately billable service unless performed as a treatment of a complication as noted above. In the latter case add 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 50500 to indicate to your payer that this is open surgery for the treatment of a complication.