August 16, 2024

Mark, Scott, and Ray talk about G2211 and 99459 updates and two CPT description questions that came into the PRS Communities:

1. I have received a denial for px 50545 stating the adrenal gland was not removed, therefore, 50545 is not supported. PX description: Laparoscopy, surgical; radical nephrectomy (includes removal of Gerota's fascia and surrounding fatty tissue, removal of regional lymph nodes, and adrenalectomy). I recall reading a PRS article regarding what constitutes a a radical nephrectomy (of course, currently I can not find my reference). But if I recall correctly, the main criteria for radical is the removal of the Gerota's facia. The nodes, adrenal and fatty tissue were not the determining factor, and did not have to be removed to classify as radical 50545. Can y'all please help direct me to the correct understanding? Does the adrenal gland have to be removed in a radical nephrectomy? Thanks for any input y'all can provide.
   
   
2. The CPT book does not define limited vs complete for penile duplex scans the way it does for other vascular studies. How do we choose between 93980 and 93981, and what do we look for in documentation to determine whether it is complete or limited If it is not a follow up? I have never had a provider perform this procedure before and want to make sure i am understanding the codes correctly. Thank you!

AMA Paranthetical Link

https://cpt-international.ama-assn.org/cpt-implementation-guide-component-2-primer

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