Urology Coding Alert

Question: Dr. A was performing a hand-assisted laparoscopic nephrectomy. Dr. B had to extend the incision and perform a ureterectomy. Each doctor assisted the other. Should I code the nephrectomy with 50545 for Dr. A, and  50545-80 for Dr. B, and then code the ureterectomy with 50650 for Dr. B, and 50650-80 for Dr. A? Or should I code them as co-surgeons with modifier -62?

North Carolina Subscriber Answer: First, consult with the physician to see if CPT code 50548 (Laparoscopy, surgical; nephrectomy with total ureterectomy) would be more appropriate than 50545 (Laparoscopy, surgical; radical nephrectomy).

For example: The laparoscopic procedure was for a malignant tumor of the renal pelvis or ureter, and Dr. A, the laparoscopic surgeon, performed a total nephroureterectomy. He then performed an open procedure for a bladder cuff excision and to ensure total removal of the intramural lower ureter. Dr. A should report 50548 because he performed a total nephroureterectomy laparoscopically. Following this, Dr. B, through an extended incisional open procedure, removed the terminal intramural ureter and a cuff of bladder to complete the operation. Dr. B should report 50650.

However: If Dr. A performed a radical laparoscopic nephrectomy with partial ureterectomy, he should report 50545. Dr. B should still report 50650. Medicare states that if each surgeon is performing a major procedure at the same encounter, neither one should bill for an assistant surgeon's charge, even if they assist each other.

If the carrier happens to be non-Medicare, private, commercial or HMO, you can bill assistant surgeon charges for both as you describe above, appending modifier -80 (Assistant surgeon) as appropriate.