Urology Coding Alert

Question: My urologist performed a ureteroneocystostomy with a psoas hitch for ureteral cancer. He also did a pelvic lymphadenectomy on the left side because the nodes were enlarged. He wants to charge for a ureterectomy, but the code definition "separate procedure" implies that is it included in the ureteroneocystostomy. How should I code this?

Arizona Subscriber Answer: There is no single CPT code that encompasses all of the procedures performed, so you have to code each procedure separately.
 
Urologists commonly perform these procedures to treat transitional cell carcinoma of the lower ureter. The urologist usually excises an adequate segment of the lower ureter, reimplants the ureter back into the bladder via ureteroneocystostomy and, in this case, does a unilateral node resection for therapeutic and staging purposes. This differs from a ureteroneocystostomy performed for other conditions, in which the minor excision and tailoring of the distal ureter is included in 50785 (Ureteroneocystostomy; with vesico-psoas hitch or bladder flap).
 
Report 50785 for the reimplantation via the Boari technique, 50650-51 (Ureterectomy, with bladder cuff [separate procedure]; Multiple procedures) for the excision of the segment of the lower ureter and 38770-51 (Pelvic lymphadenectomy, including external iliac, hypogastric, and obturator nodes [separate procedure]) for the unilateral node resection. Modifier -51 indicates to the carrier that the urologist performed multiple procedures at the same surgical session. If you stent your anastomosis with a JJ-stent, also code 50605-51 (Ureterotomy for insertion of indwelling stent, all types).