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Urology Coding Alert

Code Kidney Transplant Preparations More Accurately

Published on Sat Oct 30, 2004

CPT 2005 adds backbench codes and revises donor nephrectomy descriptors

There is often extensive work involved with back table or "backbench" preparation of a donor kidney prior to transplant. Since there are now no separate codes for renal allograft dissection, fat removal, anastomosis and other preparations, coders use the transplant codes to cover all the work - but that's due to change soon.

On Jan. 1, 2005, you'll find five new codes in the "Renal Transplantation" section of your CPT Manual, covering techniques and technologies previously ignored.

The new codes will "allow for more accurate reimbursement for some of the procedures associated with these, not previously reflected in the CPT Codes for the transplants," says Morgan Hause, CCS, CCS-P, privacy and compliance officer for Urology of Indiana LLC, a 21-urologist practice in Indianapolis.

The new renal transplantation codes, effective Jan. 1, 2005, are:

  •  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

  • CPT 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

  • CPT 50327 - Backbench reconstruction of cadaver or living donor renal allograft prior to transplantation; venous anastomosis, each

  • CPT 50328 - Backbench reconstruction of cadaver or living donor renal allograft prior to transplantation; arterial anastomosis, each

  • CPT 50329 - Backbench reconstruction of cadaver or living donor renal allograft prior to transplantation; ureteral anastomosis, each.

    Report New Codes With Revised Donor Codes

    CPT 2005 will make a key deletion from the descriptor for code 50300 (Donor nephrectomy, with preparation and maintenance of allograft, from cadaver donor, unilateral or bilateral). The phrase "with preparation and maintenance of allograft" will disappear from the 50300 descriptor - meaning that you should be able to report the preparation and maintenance with one of the new codes in addition to 50300 for transplants from a cadaver donor, Hause says. The descriptors for both 50300 and 50320 will include the phrase "including cold preservation" to "reflect the growing and changing technology and techniques in renal transplants," Hause says.

    This should be a welcome change for coders. "We always do [preparation of the graft], but we never charge for it because there's no code," says Claire Kenny, CPC, coder in the urology department of the Lahey Clinic in Burlington, Mass. "We always assumed it was included in the transplant code."

    The revised transplant codes will read as follows in the 2005 CPT manual:

  •  50300 - Donor nephrectomy (including cold preservation); from cadaver donor, unilateral or bilateral

  •  50320 - Donor nephrectomy (including cold preservation); open, from living donor

    Example: Prior to transplanting a kidney from a cadaver donor, the urologist prepares it on the back table by removing perinephric fat and preparing the veins, arteries and ureters. Previously, you could only code 50300, since it included the preparation. In 2005, you can code both 50300 and 50323.

    Find 52402 With Its New Family

    CPT 2005 also adds 52402 (Cystourethroscopy with transurethral resection or incision of ejaculatory ducts). If that description looks familiar, it's because it now belongs to 52347, which CPT will delete on Jan. 1. The change is "to move [the procedure] to a more appropriate family of codes within the CPT codes," Hause says. In the 2005 CPT manual, this procedure will move from under the "Ureter and Pelvis" heading to the "Vesical Neck and Prostate" heading.

    Look for: Another code descriptor changing in 2005 is for 52234 (Cystourethroscopy, with fulguration [including cryosurgery or laser surgery] and/or resection of; SMALL bladder tumor[s] [0.5 up to 2.0 cm]) (change in bold print). The phrase "up to" makes clear that this code is for lesions smaller than 2.0 cm, says Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology at State University of New York in Stony Brook. Therefore, for a bladder lesion 2.0 cm or larger, up the coding to CPT code 52235 (... MEDIUM bladder tumor[s] [2.0 to 5.0 cm]). If you have a 5.0-cm tumor, you would also use 52235, Ferragamo says. You should report code 52240 (... LARGE bladder tumor[s]) for bladder tumors over 5 cm.

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