Urology Coding Alert

Question: What is the code for a hand-assisted laparoscopic nephrectomy? Can I report two separate CPT codes if the urologist performed the nephrectomy portion but another physician performed the laparoscopic takedown of the splenic flexure?

Nevada Subscriber


Answer: The CPT code that best represents a hand-assisted laparoscopic nephrectomy is still the single code 50546 (Laparoscopy, surgical; nephrectomy, including partial ureterectomy), and to report co-surgeons performing this service, you will need to add modifier -62 (Two surgeons).

 The surgeon's hand placed within the abdominal cavity during laparoscopic procedures usually facilitates the procedure and takes the place of a portal site and portal instrument. If the hand assistance becomes necessary because of unexpected adverse conditions such as unusual or abnormal anatomy, excessive bleeding, or extensive fibrosis necessitating difficult dissection, you may need to append modifier -22 (Unusual procedural services) to 50546. To use modifier -22, you need documentation of the extra time and work required to do the procedure as well as documented reasons for using the hand within the abdominal cavity.

 When co-surgeons each perform a part of a laparoscopic nephrectomy, both the urologist and the general surgeon should report 50546-62. Each surgeon must dictate his own part of the operation and include a statement describing the work performed by the other surgeon. Each surgeon is also required to submit his own paper claim, operative report and short explanatory note detailing what each did, why, and what was required. If the claim is approved, Medicare and many private payers will reimburse each physician 62.5 percent of the global fee for the procedure.