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Urology Coding Alert

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Pare Down Complicated Nephrectomy Coding

Published on Mon Jan 18, 2010

Question: My urologist saw a Medicare patient with transitional cell carcinoma of his left ureter. The physician cystoscopically excised the left ureteral orifice and fulgurated the surrounding area to allow the ureter to migrate into the retroperitoneum. Then the patient was repositioned and the urologist opened in the midline inferior to the umbilicus into the peritoneal cavity. He placed trocars at 10 and 20 cm lateral to the main incision using his left hand inside the wound to make sure that no injury to the bowel occurred. He then laparoscopically removed the kidney and ureter. How should I code this procedure? Indiana Subscriber Answer: First, report 50548 (Laparoscopy, surgical; nephrectomy with total ureterectomy) for the laparoscopic total nephroureterectomy. Since your urologist removed both the kidney and the ureter via laparoscopic approach, 50548 is the appropriate code. Next, report 52214 (Cystourethroscopy, with fulguration [including cryosurgery or laser surgery] of trigone, bladder [...]
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