Urology Coding Alert

Question: A patient was taken to the operating room for robotic exploration and revision of a psoas hitch. Postoperatively after the first procedure, the patient experienced a dense femoral nerve paralysis with decreased sensation. There was concern for possible involvement of the femoral nerve with psoas hitch sutures. These were identified, robotically removed, and replaced with new sutures. The patient was able to move her leg postoperatively while still under anesthesia. The surgeon reapproximated the bladder to the peritoneum to attempt to reperitonealize the reimplantation. The original surgery was reported with codes 50947 and 52005. I realize now that 50900 is not correct. What should we report?

Arkansas Subscriber

Answer: Based on your provided documentation, code 50900 (Ureterorrhaphy, suture of ureter (separate procedure)) is not appropriate because it does not represent a robotic procedure. Currently, there is not a specific procedure code for robotic exploration and revision of psoas hitch. Therefore, you should report code 51999 (Unlisted laparoscopy procedure, bladder) and include supporting documentation.

Note: Unlisted procedure codes do not accept modifiers so a modifier such as modifier 78 (Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period) is not required as it would be for a specific CPT® code in this case. Benchmark this unlisted procedure to code 50785 (Ureteroneocystostomy; with vesico-psoas hitch or bladder flap).