Wiki Unlisted CPT 50949

[doodle96]

We have a Gyn provider that is performing a laparoscopic procedure for ureterolysis due to retroperitoneal fibrosis. However, there is not a laparoscopic CPT code for this procedure. We are using the CPT 50949 - Unlisted laparoscopic procedure, ureter with the comparable code CPT 50715 - Ureterolysis, with or without trans positioning of the ureter for retroperitoneal fibrosis. We are getting denials, stating that there is a more appropriate unlisted CPT that could be used. Is anyone else having this issue?

 

[Cmama12]

If the ureterolysis is the only thing being performed, then I would use the unlisted code. If being performed with a hysterectomy or other procedure, it would be treated like lysis of adhesions. This is the guidance from SGO on this topic:

WE HAVE A PROVIDER THAT HAS STARTED PERFORMING URETEROLYSIS FOR RETROPERITONEAL FIBROSIS. WE KNOW THAT CPT CODE 50715 IS SPECIFIC FOR THIS PROCEDURE/DIAGNOSIS OUR PHYSICIAN IS PERFORMING THE PROCEDURE LAPAROSCOPICALLY AND NOT OPEN. WOULD YOU SUGGEST REPORTING THE URETEROLYSIS WITH AN UNLISTED OR APPENDING MODIFIER 22 TO THE “MAIN” LAPAROSCOPIC PROCEDURE CODE?

CPT 50715 (ureterolysis for retroperitoneal fibrosis) describes an open procedure performed for a distinct diagnosis that’s also known as Ormond’s disease. The disease is characterized by excess fibrous tissue that develops in the retroperitoneal space behind the stomach and intestine. It is not meant to be used for ureterolysis performed due to post-inflammatory changes or postoperative adhesions. There is no analogous code for a laparoscopic approach and you should append modifier -22 to the main laparoscopic procedure. The increased work required should be clearly documented and quantified in the operative note.

 

[doodle96]

If the ureterolysis is the only thing being performed, then I would use the unlisted code. If being performed with a hysterectomy or other procedure, it would be treated like lysis of adhesions. This is the guidance from SGO on this topic:

WE HAVE A PROVIDER THAT HAS STARTED PERFORMING URETEROLYSIS FOR RETROPERITONEAL FIBROSIS. WE KNOW THAT CPT CODE 50715 IS SPECIFIC FOR THIS PROCEDURE/DIAGNOSIS OUR PHYSICIAN IS PERFORMING THE PROCEDURE LAPAROSCOPICALLY AND NOT OPEN. WOULD YOU SUGGEST REPORTING THE URETEROLYSIS WITH AN UNLISTED OR APPENDING MODIFIER 22 TO THE “MAIN” LAPAROSCOPIC PROCEDURE CODE?

CPT 50715 (ureterolysis for retroperitoneal fibrosis) describes an open procedure performed for a distinct diagnosis that’s also known as Ormond’s disease. The disease is characterized by excess fibrous tissue that develops in the retroperitoneal space behind the stomach and intestine. It is not meant to be used for ureterolysis performed due to post-inflammatory changes or postoperative adhesions. There is no analogous code for a laparoscopic approach and you should append modifier -22 to the main laparoscopic procedure. The increased work required should be clearly documented and quantified in the operative note.

Thank you for your feedback.