Wiki Robotic case

[Liz2013]

How to code a robotic partial nephrectomy with partial ureterectomy? I do not seem to find a specific code. Please advise. Thank you

 

[trarut]

Have you checked with the payer for this particular patient to see if they have a robotic surgery policy? Robotic surgeries, in my experience, are usually reported the "usual" CPT codes + S2900 to report the use of the robotic system.

 

[csperoni]

Exactly. The robot is simply a tool/device used to accomplish a laparoscopic surgery a specific way. You use the same exact laparoscopic codes. S2900 for the use of the robot (from my experience), is not paid and sometimes pends the claim, so we do not use it on the physician side.

 

[Liz2013]

Thank you for your response. We have reported robotic nephrectomies using the laparoscopic codes. There is a code for robotic nephrectomy with partial ureterectomy (cpt code 50546) which it is for the removal of the kidney with partial ureterectomy (I’m thinking this is for removal of the whole kidney). However in the case I’m trying to code, the physician did Robotic partial (only part of the kidney was removed) nephrectomy with partial ureterectomy in which I’m having a hard time coding it.

 

[trarut]

Exactly. The robot is simply a tool/device used to accomplish a laparoscopic surgery a specific way. You use the same exact laparoscopic codes. S2900 for the use of the robot (from my experience), is not paid and sometimes pends the claim, so we do not use it on the physician side.

I've actually had the same issue on the physician side with S2900 and stopped reporting it as well. But it always seems to come down to the "proper" way and how the payers really want things reported.

I still recall arguing with a Medicaid plan about 10 years ago because the reviewer insisted S2900 was the ONLY code that should be reported for a robotic surgery, not the actual surgery codes. And the person arguing with me kept insisting she was right because she was a certified coder

 

[trarut]

Thank you for your response. We have reported robotic nephrectomies using the laparoscopic codes. There is a code for robotic nephrectomy with partial ureterectomy (cpt code 50546) which it is for the removal of the kidney with partial ureterectomy (I’m thinking this is for removal of the whole kidney). However in the case I’m trying to code, the physician did Robotic partial (only part of the kidney was removed) nephrectomy with partial ureterectomy in which I’m having a hard time coding it.

Oh my, we just went totally down a side path on you, didn't we? LOL Is the procedure exactly the same as 50546 except for the partial v. full kidney removal? If so, I would use a reduced services modifier (-52) and report in the narrative field that only the part of the kidney was removed.

 

[Liz2013]

Oh my, we just went totally down a side path on you, didn't we? LOL Is the procedure exactly the same as 50546 except for the partial v. full kidney removal? If so, I would use a reduced services modifier (-52) and report in the narrative field that only the part of the kidney was removed.

I just noticed your response. Lol you are right and I appreciate your response. I was thinking the same but I doubted and I felt that I was wrong. But you give me peace that this the correct route to code this surgery. Thanks

 

[liqgold2@aol.com]

This appears to be a partial nephrectomy for a bifid or double urinary system (double ureter and renal pelvis) where a partial ureterectomy of the double ureter is also performed. Code 50534 for the partial nephrectomy and in this clinical scenario the double partial ureterectomy would be included in this code. If you would like to discuss this further concerning the anatomy involved, do not hesitate to call me at 516-721-8149
I hope this helps you.
Michael A. Ferragamo MD, FACS, urologist and coding and reimbursement consultant for urology

 

[trarut]

I just noticed your response. Lol you are right and I appreciate your response. I was thinking the same but I doubted and I felt that I was wrong. But you give me peace that this the correct route to code this surgery. Thanks

Good luck! Hope it works

 

[Liz2013]

This appears to be a partial nephrectomy for a bifid or double urinary system (double ureter and renal pelvis) where a partial ureterectomy of the double ureter is also performed. Code 50534 for the partial nephrectomy and in this clinical scenario the double partial ureterectomy would be included in this code. If you would like to discuss this further concerning the anatomy involved, do not hesitate to call me at 516-721-8149
I hope this helps you.
Michael A. Ferragamo MD, FACS, urologist and coding and reimbursement consultant for urology

Thank you Dr. Ferragamo. I just noticed you had responded after the last advice. Then I coded incorrectly. I will check on the status of this claim and make sure I will send a corrected claim.
Thank you so much for your answer.