Urology Coding Alert

Question: The physician performed a nephrectomy that was more involved than a simple nephrectomy. Can we bill for a radical nephrectomy with 50230 as opposed to 50220 for kidney cancer if no lymph node dissection is done?

Georgia Subscriber

Answer: Code 50230 (nephrectomy, including partial ureterectomy, any approach including rib resection; radical, with regional lymphadenectomy and/or vena caval thrombectomy) should not be used for a nephrectomy if a lymph node dissection was not performed. A simple nephrectomy 50220 (nephrectomy, including partial ureterectomy, any approach including rib resection) includes removal of the entire kidney and part of the ureter. If the simple nephrectomy is more complicated because of previous surgery performed on the same kidney, then 50225 (nephrectomy, including partial ureterectomy, any approach including rib resection; complicated because of previous surgery on same kidney) should be reported. If the entire ureter is removed along with the kidney, then either 50234 (nephrectomy with total ureterectomy and bladder cuff; through same incision) or 50236 (kidney and entire ureter removed through two separate incisions) should be reported. If the nephrectomy clearly consumed more physician resources than normal because of an unusual circumstance, you could report the appropriate CPT code with modifier -22 (unusual procedural services). Documentation to support the unusual nature of the surgery would have to accompany the claim.