Urology Coding Alert

Question: If my urologist does a radical nephrectomy with a retroperitoneal lymph node dissection, does code CPT 50230 include all that or should I report CPT 38780 with 50230?

Wisconsin Subscriber

Answer: When your urologist performs a radical nephrectomy and you report 50230 (Nephrectomy, including partial ureterectomy, any open approach including rib resection; radical, with regional lymphadenectomy and/or vena caval thrombectomy) this coding includes a regional lymph node resection.

If the surgeon performed a more extensive lymph node resection, consider also reporting add-on code +38747 (Abdominal lymphadenectomy, regional, including celiac, gastric, portal, peripancreatic, with or without para-aortic and vena caval nodes [List separately in addition to code for primary procedure]). For you to bill this add-on code, your urologist does not have to resect each and every one of these nodal areas.

Keep in mind: Code 38780 (Retroperitoneal transabdominal lymphadenectomy, extensive, including pelvic, aortic, and renal nodes [separate procedure]) is a complete full bilateral nodal resection as one would do for testicular tumors. It isn't likely that your urologist performed this sort of extensive bilateral procedure for a renal tumor.