Urology Coding Alert

Key: Make sure you're carefully evaluating each individual clinical scenarioAs a coder, you know all too well that every procedure is not the same. Often, you need to dig through the urologist's operative notes to select the proper codes. But even with documentation, proper code choice can prove to be a challenge with procedures such as cystoprostatectomies.Decide which CPT codes you would choose for your urologist for this case study, shared by M. Jane Marks, billing manager at Eastern Shore Urology Associates, PA in Easton, Md., and then check your answers against the experts' answers below.Scenario: The patient has muscle invasive bladder cancer. The urologist removed the bladder and performed an ileal conduit urinary diversion. The surgeon also removed the patient's prostate and performed a pelvic lymph node dissection, removing all obturator nodes.Start With the CystectomyThe primary procedures in this case are the cystectomy, ileal conduit urinary diversion, and the node resection, all performed to treat the bladder tumor. Therefore, the first code you should report is the code that encompasses or includes all of the above procedures, namely 51595 (Cystectomy, complete, with ureteroileal conduit or sigmoid bladder, including intestine anastomosis; with bilateral pelvic lymphadenectomy, including external iliac, hypogastric, and obturator nodes), says Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology for State University of New York, Stony Brook.Don't forget: You should separately report the radical prostatectomy because the urologist performed that procedure, but it is not included in the 51595 code."A number of years ago, the American Urological Association (AUA) had indicated that you should bill for the radical prostatectomy when the urologist includes this procedure with the total cystectomy," Ferragamo explains. "Most urologists surgically remove the prostate when they perform a radical cystectomy because anatomically, the prostate is so closely associated with the bladder that performing a complete cystectomy in the male mandates that you also remove the prostate."Use 55840 (Prostatectomy, retropubic radical, with or without nerve sparing) to report the radical prostatectomy, says Christy Shanley, CPC, CPC-URO, billing manager for the University of California, Irvine, department of urology. Append modifier 51 (Multiple procedures) to 55840 to show your carrier that the urologist performed the cystectomy and the prostatectomy during the same surgical session.Check with your insurer first: Attaching modifier 51 to 55840 may not work with all insurers. Many carriers, including Medicare, no longer require modifier 51. Also, remember that you can expect half the global reimbursement for codes with modifier 51 attached. (Most insurance companies have adopted Medicare's policy of paying 50 percent for codes with modifier 51 attached.)Tip: You should not bill 51595 and 55845 (Prostatectomy, retropubic radical, with or without nerve sparing; with bilateral pelvic lymphadenectomy ...) together. The Correct Coding Initiative [...]