Urology Coding Alert

Question: The urologist performed a bilateral nephrectomy because both of the patient’s kidneys were bad. He completed a kidney transplant during the same operative session. The coding edit information I have indicates that we are not allowed to bill separately for the nephrectomies and the transplant at the same encounter. Can I bill these together, or will the nephrectomies get denied?

Nevada Subscriber

Answer: The coding edit information you reference is correct. However, for this bilateral nephrectomy and renal transplant patient, you should report 50365 (Renal allotransplantation, implantation of graft; with recipient nephrectomy). Append modifier 50 (Bilateral procedure) to show that your physician removed both kidneys during the same operative session.

Code 50365 clearly states that this procedure includes a nephrectomy, and you should not report a separate nephrectomy code. Modifier 50 will indicate to the carrier that your physician deserves additional payment because he removed both kidneys.

Note: Using modifier 50 with 50365 relates to the nephrectomy part of this code, not a bilateral transplant, which the urologist did not perform. At the same time, 50360 (Renal allotransplant ... without recipient nephrectomy) does not accept or allow modifier 50.