Wiki Laparoscopic removal of spunule during nephrectomy

[KaylaRieken]

My doctor removed a spenule while doing a laparoscopic partial nephrectomy. Not really sure how to code this. Do I use 38129 unlisted or 38120? My understand is that a spenule is an accessory spleen.

 

[liqgold2@aol.com]

A spenule is a small accessory spleen found in about 10% of the population. I would consider this part of the surgery as part of the global for the partial nephrectomy, an incidental procedure, and not a separate procedure or charge. Also 38120 is bundled into 55043, laparoscopic partial nephrectomy, and can be unbundled and charged I believe if its removal constituted a significant part of the surgical time (its removal increased the total time of the surgery). In the latter case I would consider also billing 38120-52, for a lesser procedure, and modifier-XU to break the bundle between unrelated codes as well as 50543 as the primary surgery.