Urology Coding Alert

Question: A patient presents with bilateral renal masses. The mass on the left was removed in an enucleated fashion. The mass on the right was removed in a wedge fashion. According to the operative note, the case was extremely hazardous and difficult, and it was necessary for two urologists to perform the case. The surgeon also requested a -22 modifier (unusual procedural services) for increased difficulty. The Medicare Physician Fee Schedule Database states that 50240 (nephrectomy, partial) is not amenable to the -50 modifier (bilateral procedure) because the RVUs are based on the procedure being performed as a bilateral procedure. Should I just code this as a 50240 with modifiers -22 and -62 (two surgeons)?

Anonymous Wisconsin Subscriber

Answer: Yes, bill code 50240-22-62. Asking for additional reimbursement requires submission of an operative report and a cover letter so the carrier can make a determiniation on whether that request was justified. Make sure that the second physician was acting as co-surgeon and not assistant surgeon. Both physicians must dictate distinct and separate operative reports describing their portion of the procedure to bill as co-surgeons. Each note should have a reference to the other physicians portion of the surgery.