Urology Coding Alert
Laparoscopic Nephrectomy
New Jersey Subscriber
Answer: In the February 2001 issue of Urology Coding Alert, coding for hand-assisted laparoscopy (HAL) and nephrectomies (50545-50548) was discussed. The issue of bilateral nephrectomies performed by HAL was not discussed because it seemed such a rare circumstance. Medicare does not allow modifier -50 (bilateral procedure) on 50546 (laparoscopy, surgical; nephrectomy, including partial ureterectomy) and 50548 (... nephrectomy with total ureterectomy).
Bilateral billing is allowed for 50545 (radical nephrectomy [includes removal of Gerotas fascia and surrounding fatty tissue, removal of regional lymph nodes, and adrenalectomy]) and 50547 ( donor nephrectomy from living donor [excluding preparation and maintenance of allograft]).
If the former procedures are performed bilaterally, the physician should be paid for the work done. Here are several solutions:
1. File 50546 with modifier -99 (multiple modifiers) appended. Then, in block 19 of the claim form, write 99 = -LT, -RT, -51. This indicates that the procedure was performed on both sides, and the second would be paid as a multiple procedure.
2. File on two lines: 50546-LT and 50546-RT-51.
3. File on one line: 50546-50 (you will need to file the operative report and notes).
Urology Coding Alert
- Method of Access Is Key in Determining Codes for Flank Drainage
Coding for open, laparoscopic or percutaneous drainage of the flank requires a distinction between methods [...] - CPT Assistant Clarifies Modifier Use for Stents, Stones
CPT Assistant clarified several coding questions for urologists this fall including modifier use for stents [...] - You Be the Coder:
Fee for Stent Insertions
Test your coding knowledge. Determine how you would code this situation before looking at the [...] - Follow Local Policy for Transrectal Ultrasound
Transrectal ultrasound for prostatic evaluation has two codes depending on whether the ultrasound is diagnostic [...] - Anthrax Coding Report Free on Web
Physicians and other healthcare professionals who provide services to any patients with actual or possible [...] - Case Study:
Coding When Definitions Overlap
When a urologist performs multiple procedures at a surgical encounter, proper coding requires choosing between [...] - Reader Question:
Laparoscopic Nephrectomy
Question: How should I code a bilateral hand-assisted laparoscopic nephrectomy? The patient is an ESRD, [...] - Reader Question:
Pre-Existing Problem
Question: When a patient is admitted to the hospital for a non-urology problem (fractured tibia/fibula) [...]
