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Laparscopic nephroureterectomy -

David Posted Thu 25th of February, 2016 14:59:58 PM

I am new to surgery coding for Urology and I am hoping you can help me with this one. We had a provider perform a "hand assisted laparoscopic nephroureterectomy" So he went laparscopically and removed the kidney...normally our providers then also remove the ureter through the same incision.
this provider ended up using a cystoscope to enter the bladder and used a hot knife to dissect and remove the ureter from the bladder. The ureter was taken out through the cystoscope.

We have always billed 50548 when both the kidney and ureter are removed, but because used the cysto this time would we bill 50545 and bill the cysto with the removal of the ureter separately? We are thinking of using 50949 for an unlisted code for that.

Please let me know what you think on this.

Thank you

SuperCoder Answered Mon 29th of February, 2016 07:32:34 AM

Hi,

Appropriate code for this scenario would be 50548 only. Provider can use any type of endoscope to perform procedure.

A cystoscopy is a medical procedure used to examine the inside of the bladder using an instrument called a cystoscope. A cystoscope is a thin, fibre optic tube that has a light and a camera at one end. It's inserted into the urethra (the tube that carries urine out of the body) and moved up into the bladder.
Laparoscopy is a surgery that uses a thin, lighted tube put through a cut (incision) in the belly to look at the abdominal organs or the female pelvic organs. Laparoscopy is used to find problems such as cysts, adhesions, fibroids, and infection.

Thanks!

David Posted Wed 02nd of March, 2016 15:36:30 PM

Thank you for your response, but I think you might be misunderstanding what I am asking. The kidney was removed by laparoscopic approach.....we then inserted a cystoscopy through the urethra into the bladder we used the knife through the cysto to excise the ureter. We did use 2 different approaches....so would that still warrant the 50548?
Thank you

SuperCoder Answered Thu 03rd of March, 2016 03:56:44 AM

Hi,
Provider can use other instruments or an additional light source through other incisions to perform “Laparoscopy, surgical; nephrectomy with total ureterectomy”.

As code 50548 describes-
The physician removes the kidney and all of the ureter through a laparoscope. The physician makes periumbilical incision and inserts a trocar. A fiberoptic laparoscope fitted with a camera and light source is inserted through the trocar. Other incisions (ports) are made in the abdomen or flank to allow other instruments or an additional light source to be passed into the abdomen or retroperitoneum. The kidney and ureter are bagged and brought through one of the port sites (e.g., periumbilical) that has been slightly enlarged. The instruments are removed, and the small abdominal or flank incisions are closed with staple or suture.
I hope this helps!
Thanks!

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