Urology Coding Alert

Question: The urologist positioned the patient prone, sterilized and draped the site, and under general anesthesia, made four incisions below the rib cage. A laparoscope and trocars were inserted for viewing and instrument access. The right kidney, along with part of the ureter, was excised and removed. How should I code this?

Georgia Subscriber

Answer: You should report 50546 (Laparoscopy, surgical; nephrectomy, including partial ureterectomy) on your claim. “The urologist removed the right kidney in its entirety as well as the removal of a part of the right ureter connected to the bladder,” says Stephanie Storck, CPC, CPMA, CUC, CCS-P, ACS-UR, longtime urology coding expert and consultant in Glen Burnie, Maryland.

Take note: If the urologist performed a partial nephrectomy and removed only the diseased or infected portion of the kidney, you should report 50543 (Laparoscopy, surgical; partial nephrectomy) instead.

If your urologist performed a radical nephrectomy, use code 50545 (Laparoscopy, surgical; radical nephrectomy (includes removal of Gerota’s fascia and surrounding fatty tissue, removal of regional lymph nodes, and adrenalectomy), which covers the removal of the kidney, Gerota’s fascia, perinephric fat, a ureter section, possibly the adrenal gland, and regional lymph nodes. If your urologist performs the nephrectomy through a laparoscope along with the removal of a section of the ureter, report 50546.

Finally, if your urologist performs a nephrectomy with a total removal of the ureter, report 50548 (Laparoscopy, surgical; nephrectomy with total ureterectomy).