Kidney Transplant Coding in Brief

Be sure medical necessity is proven and check payer requirements.

By Amy C. Pritchett
When reporting kidney transplant, documentation must substantiate medical necessity, including a covered diagnosis.
There are several factors that insurance companies specifically deem not medically necessary for a kidney transplant, including:

Known history or current malignancy up to and including metastatic cancer
Recurrent malignancy with a high incidence of recurrence
Untreated systemic infection making immunosuppression unsafe (i.e., chronic infection)
Other irreversible end-stage diseases that are not linked to the kidney disease

Covered Diagnosis Codes*

ICD-9-CM Code	ICD-10-CM Code
250.40 Diabetes with renal manifestations, type II or unspecified type, not stated as uncontrolled	E11.29 Type 2 diabetes mellitus with other diabetic kidney complication
250.41 Diabetes with renal manifestations, type I (juvenile type) not stated as uncontrolled	E10.29 Type 1 diabetes mellitus with other diabetic kidney complication
250.42 Diabetes with renal manifestations, type II or unspecified type, uncontrolled	E11.65 Type 2 diabetes mellitus with hyperglycemia
250.43 Diabetes with renal manifestations, type I (juvenile type), uncontrolled	E10.65 Type 1 diabetes mellitus with hyperglycemia
403.01 Hypertensive chronic kidney disease, malignant, with chronic kidney disease stage V or end stage renal disease	I12.0 Hypertensive chronic kidney disease with stage 5 chronic kidney disease or end stage renal disease
403.11 Hypertensive chronic kidney disease, benign, with chronic kidney disease stage V or end stage renal disease	I12.0
403.91 Hypertensive chronic kidney disease, unspecified, with chronic kidney disease stage V or end stage renal disease	I12.0
581.81 Nephrotic syndrome in diseases classified elsewhereCode first the underlying disease.	N08 Glomerular disorders in diseases classified elsewhere
582.1 Chronic glomerulonephritis, with lesion of membranous glomerulonephritisFocal glomerulosclerosis	N03.3 Chronic nephritic syndrome with diffuse mesangial proliferative glomerulonephritis
585.1 Chronic kidney disease, Stage I	N18.1 Chronic kidney disease, stage 1
585.2 Chronic kidney disease, Stage 2	N18.2 Chronic kidney disease, stage 1 (mild)
585.3 Chronic kidney disease, Stage 3	N18.3 Chronic kidney disease, stage 1 (moderate)
585.4 Chronic kidney disease, Stage 4	N18.4 Chronic kidney disease, stage 4 (severe)
585.5 Chronic kidney disease, Stage 5	N18.5 Chronic kidney disease, stage 5
585.6 End stage renal disease	N18.6 End stage renal disease
585.9 Chronic kidney disease, unspecified	N18.9 Chronic kidney disease, unspecified
753.12 Polycystic kidney, unspecified type	Q61.3 Polycystic kidney, unspecified
753.13 Polycystic kidney, autosomal dominant	Q61.2 Polycystic kidney, adult type
753.14 Polycystic kidney, autosomal recessive	Q61.19 Other polycystic kidney, infantile type
996.81 Complications of transplanted kidney	T86.10 Unspecified complication of kidney transplantT86.11 Kidney transplant rejectionT86.12 Kidney transplant failure
*This is not a comprehensive list of covered diagnosis codes, which may vary by payer. Check with your individual payer/contract for a complete listing.

Procedure Codes
Procedure coding for kidney transplant varies depending on the individual case and the services involved. Kidney transplant-related CPT® codes include:

CPT® Code	Description
00868	Anesthesia for extraperitoneal procedures in lower abdomen, including urinary tract; renal transplant (recipient)
01990	Physiological support for harvesting of organ(s) from brain-dead patient
50300	Donor nephrectomy (including cold preservation); from cadaver donor, unilateral or bilateral
50320	Donor nephrectomy (including cold preservation); open, from living donor
50323	Backbench standard preparation of cadaver donor renal allograft prior to transplantation, including dissection and removal of perinephric fat, diaphragmatic and retroperitoneal attachments, excision of adrenal gland, and preparation of ureter(s), renal vein(s), and renal artery(s), ligating branches, as necessary
50325	Backbench standard preparation of living donor renal allograft (open or laparoscopic) prior to transplantation, including dissection and removal of perinephric fat and preparation of ureter(s), renal vein(s), and renal artery(s), ligating branches as necessary
50327	Backbench reconstruction of cadaver or living donor renal allograft prior to transplantation; venous anastomosis (each vein)
50328	Backbench reconstruction of cadaver or living donor renal allograft prior to transplantation, arterial anastomosis (each)
50329	Backbench reconstruction of cadaver or living donor renal allograft prior to transplantation, ureteral anastomosis (each)
50340	Recipient nephrectomy (separate procedure)
50360	Renal allotransplantation; implementation of graft, excluding donor and recipient nephrectomy (without recipient nephrectomy)
50365	Renal allotransplantation, implantation of graft; with recipient nephrectomy
50370	Removal of transplanted renal allograft
50380	Renal autotransplantation, reimplantation of kidney

ICD-9-PCS (or Volume III) codes for facility reporting of kidney transplant include:

ICD-9-PCS Code	ICD-10-PCS Code
00.91 Transplant from live related donor	0TY00Z0 Transplantation of right kidney, allogeneic, open approach
00.92 Transplant from live non-related donor	0TY00Z1 Transplantation of right kidney, syngeneic, open approach
00.93 Transplant from cadaver	0TY00Z2 Transplantation of right kidney, zooplastic, open approach0TY10Z0 Transplantation of right kidney, allogeneic, open approach0TY10Z1 Transplantation of right kidney, syngeneic, open approach OTY10Z2 Transplantation of right kidney, zooplastic, open approach
55.51 Nephroureterectomy55.52 Nephrectomy of remaining kidney55.53 Removal of transplanted or rejected kidney 55.54 Bilateral nephrectomy 55.61 Renal autotransplantation 55.69 Other kidney transplantation	0TB00ZZ Excision of right kidney, open approach0TB10ZZ Excision of left kidney, open approach0TT00ZZ Resection of right kidney, open approach 0TT10ZZ Resection of left kidney, open approach 0TT20ZZ Resection of bilateral kidneys, percutaneous endoscopic approach

Coding Guidelines
Per CPT® instructions, do not report 50323 with 60540 Adrenalectomy, partial or complete, or exploration of adrenal gland with or without biopsy, transabdominal, lumbar or dorsal (separate procedure) or 60545 Adrenalectomy, partial or complete, or exploration of adrenal gland with or without biopsy; transabdominal, lumbar or dorsal (separate procedure); with excision of adjacent retroperitoneal tumor.
When reporting bilateral procedures, append modifier 50 Bilateral procedure to 50340 and 50365.
Example: The patient has bilateral kidney failure and is undergoing bilateral recipient transplantation. The surgeon must remove both kidneys for the transplantation; append modifier 50 to 50365 Renal allotransplantation, implantation of graft; with recipient nephrectomy to describe bilateral nephrectomy and renal allotransplant.
For renal autotransplantation extra-corporeal (bench) surgery, report autotransplantation as the primary procedure and other procedures (i.e., partial nephrectomy, nephrolithotomy) as secondary procedure(s).
Example: The patient is undergoing an autotransplantation of the kidney (50380). The physician performs a nephrolithotomy (e.g., 50060-50075) at the same session because the patient has several stones located in the unaffected kidney. In this situation, the CPT® codebook directs us to append modifier 51 Multiple procedures to the nephrolithotomy; however, many payers do not require the use of modifier 51. Check with your payer for specifics.

Amy C. Pritchett, CPC, CANPC, CASCC, CEDC, CRC, CCS, CDMP, CMPM, ICDCT-CM, ICDCT-PCS, CMRS, C-AHI, is an outpatient educator/auditor for Himagine Solutions, Tampa, Florida. She also owns and operates her own coding/billing/and auditing company, Gulf Coast HIM Solutions, Mobile. Pritchett has been a medical coder for over 20 years.