Urology Coding Alert

Question: Our physicians did a laparoscopic nephroureterectomy with an open intravesical ureterectomy and an open excision of a bladder cuff for a malignant renal pelvic tumor. During the lap portion, the surgeon also did lymph node dissection, as follows: "I removed any residual fatty and lymphatic tissue lateral to the vena cava from the level of the renal artery down to a portion just above the bifurcation of the aorta and vena cava ..." I have the nephrectomy coded as 50236 with diagnosis codes 189.0 and V64.41. But should I bill the lymph separately? Or, should I use an unlisted code to incorporate the nephrectomy and lymph node dissection? Minnesota Subscriber Answer: You should not use 50236 (Nephrectomy with total ureterectomy and bladder cuff; through separate incision) since 50236 represents an open procedure. You also shouldn't use an unlisted code for this procedure. Instead, you should first report 50548 (Laparoscopy, [...]