Urology Coding Alert

Question: A 65-year-old patient underwent a radical cystectomy for bladder cancer, with an ileal conduit diversion ( CPT 51595 ). Six months later, she was diagnosed with urethral carcinoma in situ and underwent a "total anterior urethrectomy." How should I code this?

Arizona Subscriber
 
Answer: For a female radical cystectomy, you should code 53210 (Urethrectomy, total, including cystostomy; female). For the same procedure performed on a male, report 53215 (... male). Because the procedure includes a suprapubic cystostomy in a patient whose bladder has been removed, you must add modifier -52 (Reduced services) to 53215. Submit a paper claim, and include the operative report. Be sure to include a note explaining the procedure exactly. Note that the urethrectomy is the major part of 53210 or 53215, constituting 80 percent of the full procedure. The payer will likely pay 75 percent of the full fee.
 
When a female undergoes a radical cystectomy, the urologist usually removes the total urethra in continuity with the cystectomy specimen. Code 53210 is bundled into 51595, indicating this anatomic difference between the male and female outflow tract.