Urology Coding Alert

3 answers can boost your reimbursement by 30 percent Can't find a code for a hand-assisted laparoscopic nephrectomy? You're not alone. Many coders are still confused about how best to get reimbursed for this relatively new procedure, but this expert advice will set your claims on the right track.

In hand-assisted laparoscopic (HAL) surgery, the urologist makes small incisions for insertion of scopes and instruments, and an extra incision for his hand to assist with the surgery. HAL surgery can significantly reduce operative time and the risk of complications during complex procedures, and can lead to a shorter recovery time. While that's good news for the patient, you might not want to mention that in any appeal letters you write explaining the procedure.

"Insurance companies tend to equate quicker recoveries with simpler procedures and may pay you less," says Alice Kater, CPC, coder for Urology Associates of South Bend, Ind. It isn't a simpler procedure, though: "It takes longer, it's more complex, and you need more training." 1. How should I account for the additional work involved in HAL when submitting my claim? If a urologist performs a radical nephrectomy using HAL surgery, for example, you would report 50545-22 (Laparoscopy, surgical; radical nephrectomy; unusual procedural services) to account for the complexity of the procedure -- but only if you can justify and document that the procedure is truly greater than usually required.

For example, if the urologist requires the hand assistance to complete the surgery because of extensive fibrosis or excessive vasculature, and this extra work prolongs the surgical time, you can append -22 as long as you document the facts. You would have to send in a paper, rather than an electronic, claim.

A paper claim will trigger an automatic review by the insurer, so send the operative note, says Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology at the State University of New York in Stonybrook. You should also send a short letter explaining the procedure in layman's terms, since the person reviewing your claim will likely not be a medical professional.

"Probably the most important thing," Ferragamo says, "is to put down the extra time it took you to do this procedure as compared to a laparoscopic radical nephrectomy. Then indicate how much more you want the carrier to pay you." Used appropriately, he says, modifier -22 can add 25 to 30 percent to your HAL nephrectomy reimbursement. 2. Will an insurer pay for HAL if I report both an open procedure code with modifier -52 and a laparoscopy code? Even though HAL requires special skill, Ferragamo advises against billing for both a laparoscopy procedure and an open procedure code, appending -52 (Reduced services) [...]