Urology Coding Alert

Question:My urologist does what he calls a robotic assisted nephroureterectomy. He removes the kidney and robotically dissects the ureter as far as possible.  He then undocks the robot and makes a lower abdominal incision for open removal of the intramural ureter and the bladder cuff.  He says this is the way he always does it, and that this procedure should not be considered a conversion of a laparoscopic procedure to an open operation. With this in mind, how should I report this?South Dakota SubscriberAnswer:First, report 50548 (Laparoscopy, surgical; nephrectomy with total ureterectomy) for the laparoscopic nephroureterectomy. Then, report 50650 (Ureterectomy, with bladder cuff [separate procedure]) for the open bladder cuff excision and lower intramural ureterectomy. Since 50650 is bundled into 50548, append modifier 59 (Distinct procedural service) to 50650 to indicate the separate nature of these two procedures. This does not represent the conversion of a laparoscopic procedure to an open one. [...]