Wiki endo resection of bladder cuff B4 laparascopic robotic-assisted nephroureterectomy

[noreen.cooper@reidhealth]

I have a procedure for a laproscopic nephroureterectomy. Before the nephroureterectomy was done the note is as follows: Pt placed in lithotomy position, prepped and draped. A 23-French resectoscope was placed under direct obturator visualization and using a Collings knife, a circumferential incision was made around the right ureteral orifice using previously placed stent as guide. This was resected all the way through the detrusor muscle, until fat was identified. Once completed, a 3-way 20 French irrigation catheter was placed. Then the surgeon went on to do the laproscopic nephroureterectomy.

Can anyone tell me what code to use for the endoscopic portion of this procedure? I coded it as 50548RT, 5065059RT but insurance has denied my second code for bundling. Any help appreciated.

 

[emcee101]

Without the op note to read, it sounds like the physician decided to do some or all of the resection of the distal portion of the ureter through the resectoscope as opposed to doing it all laproscopically. Either way, the work would still have been performed as part of the overall procedure and therefore, I would not bill for this as a separate procedure since your first billed code includes a total ureterectomy.