Urology Coding Alert

Also, avoid reporting drug administration with other urologic procedures - unless you've got the right reason You're used to your urologist performing an adrenalectomy when he performs a radical nephrectomy. But if you're used to coding separately for the adrenalectomy, prepare for a rude awakening, thanks to version 11.2 of the National Correct Coding Initiative.

The most recent set of NCCI Edits took effect on July 1. In these edits, NCCI determined that CPT Codes 60540 (Adrenalectomy, partial or complete, or exploration of adrenal gland with or without biopsy, transabdominal, lumbar or dorsal [separate procedure]), 60545 (...with excision of adjacent retroperitoneal tumor) and 60650 (Laparoscopy, surgical, with adrenalectomy, partial or complete, or exploration of adrenal gland with or without biopsy, transabdominal, lumbar or dorsal) are now intrinsic components of:
   50220 - Nephrectomy, including partial ureterectomy, any open approach including rib resection
   50225 - ... complicated because of previous surgery on same kidney
   50230 - ... radical, with regional lymphadenectomy and/or vena caval thrombectomy
   50234 - Nephrectomy with total ureterectomy and bladder cuff; through same incision
   50236 - ... through separate incision
   50240 - Nephrectomy, partial
   50546 - Laparoscopy, surgical; nephrectomy, including partial ureterectomy
   50548 - ... nephrectomy with total ureterectomy. Additionally, 60650 is bundled into 50543 (Laparoscopy, surgical; partial nephrectomy).

All of these bundles are marked with modifier indicator "1," which means you may unbundle the codes by appending modifier 59 (Distinct procedural service), if you can show that the services were truly separate and distinct, says Donna Bertrand, coder and biller for Siouxland Urology in Dakota Dunes, S.D.

Don't Code Separately for Node Dissection The new edits reflect long-standing urological practice, experts say.

"An adrenalectomy is included in all radical nephrectomies, whether performed open or laparoscopically," says Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology at the State University of New York in Stony Brook. NCCI is also including an adrenalectomy as part of a simple nephrectomy - one that requires the urologist to remove the adrenal gland but is not a radical nephrectomy, since there was no node dissection, Gerota's fascia removal or thrombectomy, he says.

"NCCI does not feel an adrenalectomy in these cases warrants a separate charge, and I tend to agree with this,"  Ferragamo says. "I have been involved with an adrenalectomy during a simple nephrectomy on several occasions, and I never charged separately for the adrenalectomy. It appeared part of the dissection in removing either the entire kidney or an upper pole of the kidney."

"The surgeons in my group have always felt the adrenalectomy done with a radical nephrectomy was included," agrees Morgan Hause, CCS, CCS-P, privacy and compliance officer for Urology of Indiana LLC, a 31-urologist practice in Indianapolis.

The American Urological Association feels [...]