Urology Coding Alert

Question: Our doctor removed a transplanted kidney (CPT 50370 ) due to rejection and also removed the native kidney (50220) due to a possible malignant renal mass. Both nephrectomies were performed with separate incisions and closures. We will be using modifier 22 due to scar tissue from the previous surgery. Code 50370 has an MUE of 1 and 50220 is bundled with no modifier allowed, per CCI. Code 50220 has an MUE of 2. For a Medicare patient, would it be appropriate to code 50220 and 50220-59?

Oklahoma Subscriber

Answer: You should report 50370 (Removal of transplanted renal allograft) for the transplanted kidney removal. Then, report 50220 (Nephrectomy, including partial ureterectomy, any open approach including rib resection) for the simple nephrectomy your urologist also performed. Append modifier 59 (Distinct procedural service) to 50220 to indicate the separate nature of the procedures.

Watch out: The Correct Coding Initiative (CCI) bundles 50220 into 50370 with a modifier indicator of "0," which means you cannot break or bypass the edit. In this case, however, you should report both procedures using modifier 59. Your contractor will likely deny 50220-59.

Appeal this denial based on the fact that your urologist removed the two kidneys from two different locations and for different reasons. Support the medical necessity for both procedures using 996.81 (Complications of transplanted kidney) with 50370 and 239.5 (Neoplasm of unspecified nature, other genitourinary organs) with 50220. Be prepared to supply the contractor with strong documentation, including the operative report and a cover letter explaining what your urologist did and why.

Skip 22: Unless the transplant nephrectomy procedure was extremely difficult and time consuming, you should not add modifier 22 (Unusual procedural service) to 50370. That code is valued to account for a rather difficult dissection common in a transplant nephrectomy.