AHA Coding Clinic® for HCPCS - 2026 Quarter 3; Ask the Editor

Laparoscopic Radical Nephrectomy

A patient with renal cell carcinoma presented for a laparoscopic right radical nephrectomy. The patient was placed under general anesthesia and positioned in the left lateral decubitus position. Pneumoperitoneum was established and multiple robotic trocars were placed. The colon was mobilized and the duodenum kocherized to expose the right kidney and renal hilum. The gonadal vein and ureter were identified and mobilized. Dissection of the renal hilum revealed a single renal artery and vein. Gerota’s fascia was incised and the kidney was mobilized. A lower pole renal mass was identified and initially approached for partial nephrectomy; however, intraoperative findings suggested invasion into the renal sinus fat and collecting system, and the procedure was converted to a robotic radical nephrectomy. The renal hilum was stapled and divided en bloc, the ureter was clipped and divided, the remaining perinephric attachments were released and the kidney with surrounding perinephric tissue was removed. The adrenal gland was preserved and  no regional lymph nodes were removed. The kidney was placed in a specimen retrieval bag and removed through an extraction incision. Hemostasis was confirmed and the incisions were closed. CPT code 50545 , Laparoscopy, surgical; radical nephrectomy (includes removal of Gerota’s fascia and surrounding fatty tissue, removal of regional lymph nodes, and adrenalectomy) , has a parenthetical statement indicating that removal of Gerota’s fascia, regional lymph nodes, and adrenalectomy are included. If a laparoscopic radical nephrectomy is performed but the adrenal gland is spared and no regional lymph nodes are removed, is it appropriate to report CPT code 50545 ? ...

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