Urology Coding Alert

Report recipient nephrectomy with 50340.

Combing through the numerous kidney transplant CPT^® codes and corresponding guidelines can seem very daunting. For example, you must check the documentation for details such as whether the donor is a cadaver or living. You must also understand the difference between allotransplantation and autotransplantation.

Check out this handy guide to keep your kidney transplant codes in tip-top shape.

Turn to These Codes for Donor Nephrectomy

If your urologist or a transplant surgeon performs a donor nephrectomy, which is the removal of a kidney or part of a kidney, you have the following two codes to choose from:

• 50300 (Donor nephrectomy (including cold preservation); from cadaver donor, unilateral or bilateral)
• 50320 (Donor nephrectomy (including cold preservation); open, from living donor)

When it comes to the difference between these codes, report 50300 when the kidney is from a cadaver donor. Report 50300 whether one or both kidneys are removed from the donor after death. On the other hand, use 50320 when a single kidney is removed from a live donor.

Don’t miss: Both codes include cold preservation of the kidney, as per the code descriptors.

Focus on Backbench Standard Preparation Codes

In some cases, your urologist or transplant surgeon might use backbench standard preparation for the kidney transplant. A backbench is a sterile environment in the operating room (OR) but separate from the operating table where the transplant surgeon or a urologist prepares grafts before transplantation.

You have numerous codes to choose from for backbench standard preparation for a kidney transplant. They are as follows:

Code 50323: With code 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), the transplant surgeon makes a donor kidney from a cadaver ready for the transplant through a standard backbench preparation.

Tip: Never report code 50323 in conjunction with codes 60540 (Adrenalectomy, partial or complete, or exploration of adrenal gland with or without biopsy, transabdominal, lumbar or dorsal (separate procedure)) or 60545 (… with excision of adjacent retroperitoneal tumor).

Code 50325: With code 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), your urologist makes a donor kidney from a living donor ready for transplantation through a standard backbench preparation.

Code 50327: With code 50327 (Backbench reconstruction of cadaver or living donor renal allograft prior to transplantation; venous anastomosis, each), your urologist performs backbench venous reconstruction to extend the renal vein on a kidney from either a cadaver or living donor before the transplant.

Code 50328: With code 50328 (Backbench reconstruction of cadaver or living donor renal allograft prior to transplantation; arterial anastomosis, each), your urologist prepares an arterial allograft from a cadaver or living donor kidney in order to transplant it.

Code 50329: With code 50329 (Backbench reconstruction of cadaver or living donor renal allograft prior to transplantation; ureteral anastomosis, each), the transplant surgeon or your urologist prepares a renal allograft, including joining arteries, from a cadaver or living donor kidney to prepare for the transplant.

Use 50340 for Recipient Nephrectomy

You have one code, 50340 (Recipient nephrectomy (separate procedure)), to report for a recipient nephrectomy. For a bilateral procedure, you should append modifier 50 (Bilateral procedure) to 50340.

During a 50340 procedure, the patient, which is the kidney recipient, is placed in the supine position. The surgeon prepares the site with Betadine and drapes the patient in a sterile fashion. While the patient is under general anesthesia, the surgeon makes an incision below the ribcage to expose the kidney. They will disconnect the ureter, which is the connection from the kidney to the bladder, and the blood vessels to remove the kidney.

Your urologist may be called upon to remove the kidney because it is no longer functioning. The removal of the nonfunctioning kidney makes way for the donor kidney to be transplanted.

Differentiate Between Allotransplantation, Autotransplantation

Your urologist can perform renal allotransplantation or autotransplantation. With allotransplantation, an organ or tissue is transferred between genetically different individuals of the same species. With autotransplantation, organs or tissues are excised from an individual and relocated into a new location in the same individual, says Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology, State University of New York, Stony Brook.

If a transplant surgeon transplants a kidney and ureter from a cadaver or living donor into a recipient, you should report code 50360 (Renal allotransplantation, implantation of graft; without recipient nephrectomy), Ferragamo explains. Your urologist will not remove a kidney from the recipient during this procedure.

On the other hand, if your urologist or transplant surgeon transplants a kidney and ureter from a cadaver or living donor into a recipient and also removes a kidney from the recipient, you should report code 50365 (Renal allotransplantation, implantation of graft; with recipient nephrectomy).

Tip: If the surgeon performs a bilateral procedure, append modifier 50 to code 50365.

Lastly, for allografts, you can report 50370 (Removal of transplanted renal allograft) when your urologist removes a previously transplanted donor kidney from the recipient because the recipient’s body has actively rejected it.

Autotransplantation: For autotransplantation, you have one code — 50380 (Renal autotransplantation, reimplantation of kidney). In this procedure, your urologist removes the patient’s kidney from the normal anatomic location and reimplants it into a new site by connecting renal and iliac vessels.

Don’t miss: If your urologist performs renal autotransplantation extra-corporeal [bench] surgery, you should report 50380 as the primary procedure and report the appropriate secondary procedure such as a partial nephrectomy, 50240, or nephrolithotomy, 50060, appended with modifier 51 (Multiple procedures), per CPT^®.

Hone in on Included Components

When your urologist performs renal allotransplantation, you will see three components of their work in the documentation, per CPT^®.

Component 1: The donor nephrectomy: In the case of a cadaver donor nephrectomy, this can be unilateral or bilateral. The procedure includes harvesting the graft(s) and cold preservation of the graft(s). Report code 50300 for this procedure.

On the other hand, for a living donor nephrectomy, which includes harvesting the graft and cold preservation of the graft, report 50320 or 50547.

Component 2: Backbench work: For a cadaver donor, the backbench work includes standard preparation of the renal allograft before the transplant. The preparation involves dissection and removal of perinephric fat; diaphragmatic and retroperitoneal attachments; the excision of the adrenal gland; and the preparation of ureter(s), renal vein(s), and renal artery(s), as well as ligating branches, as necessary, according to CPT^®. You should report 50323 for this procedure.

On the other hand, standard preparation of a living donor renal allograft can be open or laparoscopic. Before the transplant, the preparation includes the dissection and removal of perinephric fat and preparation of ureter(s), renal vein(s), and renal artery(s), as well as ligating branches, as necessary, according to CPT^®. You should report 50325 for this procedure.

Component 3: Recipient renal allotransplantation: This includes the transplant of the allograft. There may or may not be a recipient nephrectomy. This also includes care of the recipient. You should report code 50360 or 50365 for this procedure.

Don’t miss: “These three components should each be coded and billed appropriately for the renal transplant surgery,” Ferragamo explains. “In modern transplant surgery, the general urologist is not often involved in renal transplantation. The majority of renal transplants are performed by specially trained transplant surgeons who may on occasion also be trained urologists.”