Urology Coding Alert

Tip: Scrutinize documentation so you don’t miss reporting additional procedures When urologists perform radical nephrectomies, there’s no cookie-cutter way to report each procedure. Look at the factors and services leading up to the surgery to make sure you’re not oversimplifying the coding process and missing additional codes you should be reporting. Report Biopsies That Lead to Surgery Urologists may perform a radical nephrectomy after they perform a renal biopsy that reveals a malignant tumor. Your key to capturing payment for the biopsy and the nephrectomy procedure is modifier 59 (Distinct procedural service).
 
If a positive pathology report on a frozen section leads your urologist to perform a radical nephrectomy, you should report 50230 (Nephrectomy, including partial ureterectomy, any open approach including rib resection; radical, with regional lymphadenectomy and/or vena caval thrombectomy) and 50205-59 (Renal biopsy; by surgical exposure of kidney; Distinct procedural service), says Christy Shanley, CPC, billing manager for the University of California, Irvine department of urology.
 
Reasoning: Modifier 59 overrides the National Correct Coding Initiative edit that considers 50205 to be a component procedure of CPT 50230. You should unbundle the renal biopsy from the radical nephrectomy because the biopsy was a separate procedure, the results of which led to the decision for a nephrectomy.
 
Tip: If your urologist also performs an adrenalectomy, NCCI Edits, as well as the American Urological Assoc-iation, say you can’t separately report that procedure in addition to the nephrectomy. Code Both Partial and Radical When Appropriate When a frozen section of a removed portion of the kidney (partial nephrectomy) reveals incomplete removal of a tumor, your urologist may then decide to perform a radical procedure and completely remove the remaining portion of the kidney during the same surgical session. Your challenge is deciding whether you can report both procedures or just one.
 
Under these circumstances, remember that the urologist decided to perform a radical nephrectomy based on the pathology report of the partial nephrectomy specimen. When your physician performs a radical nephrectomy after already performing the partial, you should code both. And you should also expect to be reimbursed for both services because the National Correct Coding Initiative does not bundle these two procedures.
 
Bottom line: Report both 50240 (Nephrectomy, partial) and 50230 together. Append modifier 51 (Multiple procedures) to 50230 to show the carrier that your urologist performed the two procedures during a single surgical encounter in the same area of the body and that they should be separately reimbursed.
 
Report 50240 as the primary procedure because this procedure has higher RVUs and pays more than 50230, which you [...]