Urology Coding Alert

Question: My doctor transplanted a kidney and per-formed the backbench reconstruction as well. I know for the backbench I report CPT 50327 , 50328 and 50329. The physician feels there should be extra charges for two microvascular repairs that took an extra three hours and were very difficult. I'm having trouble finding the appropriate code and do not feel adding modifier 22 to any of the backbench codes would be enough reimbursement for his extra time. How would you suggest I code this procedure?Ohio SubscriberAnswer: There aren't any additional codes that you should report in this case. The surgeon is given extra payment with the backbench codes.You should report 50327 (Backbench reconstruction of cadaver or living donor renal allograft prior to transplantation; venous anastomosis, each), 50328 (... arterial anastomosis, each) and 50329 (... ureteral anastomosis, each), as you suggest.Note: The arterial anastomoses are covered with CPT code 50328 and cannot be separately reported with another code.Best bet: Appending modifier 22 (Increased procedural services) to 50328 would seem appropriate in this particular case to show the extra time and work your urologist had to put in for this complicated procedure.Remember that all of this information should be clearly documented in the medical records and sent to the carrier for review.