Marisela Posted 1 month(s) ago
My urologist was asked to remove 2 EXTREMELY large kidneys (30 lbs total) because there was no room to transplant new kidneys. Both physician and op report auditor code 50220-22-50; however, I am coming up with 50340-22-50. Please advise; op report below:
INDICATIONS FOR PROCEDURE:
The patient is a gentleman with end-stage kidney disease and huge bilateral polycystic kidneys occupying the entire abdomen. The patient was initially scheduled for donor kidney transplant recipient but was canceled because there was no room for the transplant kidneys; I was asked by the transplant surgery department to remove the huge bilateral polycystic kidneys so that they can make room the the new kidney transplant. The patient understands the risks, indications, contraindications and benefits of the procedure and signed the informed consent.
The patient received clearance from cardiology and nephrology as well as the transplant service.
DESCRIPTION OF PROCEDURE:
The patient was steriley prepped and draped in a supine position. IV antibiotics were given. Foley catheter was placed. SCD hose was applied. A midline incision was then made from the umbilicus above to the midline xyphoid as well as down to the pubic bone. Rectus fascia was opened, and the entire abdomen was examined carefully. There were huge cysts on both sides. It was apparent that the cyst was so large that it would not be possible to remove the kidneys via the laparoscope.
Dissection was done to mobilize the bowel medially off the kidney and the entire kidney was freed up using the LigaSure as well as Bovie. Great trouble was encountered trying to mobilize the kidney because of the huge size. This kidney was approximately 10 times the size of a normal kidney, and there was loss of resistance with mobilizing the kidney. We had lots of trouble. After freeing the kidney anteriorly, posteriorly and inferiorly with great difficulty, we approached the hilum. One renal vein and one renal artery was identified and individually transected and ligated with staple gun. The upper kidney was then freed up leaving the adrenal gland alone. After freeing the kidney up, the entire kidney was then brought out through the incision. This procedure was very difficult taking approximately 4 hours, which is about twice as long as a normal left nephrectomy. No bleeding points were encountered.
At this point, attention was then paid to the right side where identical similar fashion, a humongous right polycystic kidney was removed. This kidney also was approximately 10 times the normal size of a normal kidney and took twice as long to remove during surgery. Dissection was done inferiorly, superiorly and posteriorly until the entire kidney was freed up. The ureter was then transected and clipped like the other side. The renal hilum was dissected out and one renal vein and one renal artery was identified, transected and staple gunned. The entire kidney was then brought out through the incision leaving the adrenal alone and not removed. The patient still has bilateral intact adrenal gland. This kidney was removed entirely with difficulty because of the huge size, and no bleeding points were encountered.
SuperCoder Posted 1 month(s) ago
The appropriate code for the above procedure is CPT code 50340.
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