Revenue Cycle Insider

Identify the difference between laparoscopic and robotic prostatectomies.

In the third installment on prostatectomies, we will cover prostatectomies performed laparoscopically or with robotic assistance. As a urology coder, you should be aware that select codes only apply to certain patients that enter a urology practice. Prostatectomies are procedures that have gender-specific coding rules, and it’s important to understand the different approaches to each surgery to ensure your claims are accurate.

This is the final article in the series describing the distinct types of prostatectomies. Read on to learn about prostatectomy procedures with laparoscopic or robotic assistance approaches.

What Is a Prostatectomy Procedure?

As discussed in the previous articles, the prostate is a walnut-sized gland located under the bladder and next to the rectum of people assigned male at birth (AMAB). The gland surrounds the urethra, which is a tube that transports urine from the bladder and through the penis. The prostate plays a significant role in sexual reproduction. It helps make semen, the fluid that carries sperm out of the penis — via the urethra — during ejaculation.

A prostatectomy is performed via a laparoscopic or robotic-assisted approach for prostate cancer through small incisions (cuts) made in the abdomen.

Know What Laparoscopic and Robotic-Assisted Approaches Entail

A surgeon performs a laparoscopic prostatectomy by making small incisions in the abdomen and removing the prostate and surrounding tissue, as needed. The surgeon uses long, thin instruments with a camera (laparoscope) to view the anatomy. The surgeon performs this procedure by hand with the help of a 2D camera.

On the other hand, a robotic-assisted prostatectomy uses a robotic system (commonly known as the da Vinci Surgical System) to remove the prostate. The surgeon sits at a console and controls the robotic arms equipped with surgical instruments and a high-definition 3D camera.

The advantage of using the laparoscopic or robotic-assisted approaches is they involve only a few small incisions versus larger ones used in traditional open surgery. This makes the procedure much easier on the patient’s body. The procedures result in less pain, less scarring, and less need for narcotics during and after surgery. Although there can be complications, the risk of complications developing is reduced with the laparoscopic or robotic-assisted prostatectomy.

The laparoscopic and robotic-assisted prostatectomies use the same CPT^® code. However, documentation must identify the use of the laparoscope or robotic-assisted prostatectomy. Review the code and descriptor below:

• 55866 (Laparascopy, surgical prostatectomy, retropubic radical, including nerve sparing, includes robotic assistance, when performed)

Break Down the Laparoscopic Prostatectomy

During a radical laparoscopic prostatectomy, several small incisions are made in the wall of the lower abdomen. The laparoscope is inserted through one opening to guide the surgery. Surgical instruments are inserted through the other openings to remove the prostate. The surgeon attempts to protect the nerves that control penile erection and the bladder from damage.

Examine the Robotic-Assisted Laparoscopic Prostatectomy

During robot-assisted laparoscopic radical prostatectomy, several small cuts are made in the wall of the lower abdomen. The surgeon inserts an instrument with a camera through one of the openings and surgical instruments through the other openings using the robotic arms. The camera gives the surgeon a clear, 3D view of the prostate and surrounding structures. The surgeon then uses the robotic arms from a console in the operating suite to remove the prostate. An attempt is made to protect the nerves that control penile erection and the bladder from damage.

This procedure is also called robotic laparoscopic radical prostatectomy.

Learn How to Report Laparoscopic Lymph Node Removal

At times, the prostate cancer may have or has invaded the nearby lymph nodes. In these cases, you have multiple coding options for lymphadenectomy (removal of the lymph nodes) or lymph node biopsy procedures available to report with the prostatectomy. Since there are no laparoscopic or robotic-assistance prostatectomy codes that include the laparoscopic removal or biopsy of lymph nodes, the removal and biopsy procedures must be reported separately from 55866. The CPT^® codes with the lower relative value units (RVUs) will be subject to the multiple procedure reduction. Here’s a look at the codes you’ll be choosing from:

• Use 38570 (Laparoscopy, surgical; with retroperitoneal lymph node sampling (biopsy), single or multiple) if the retroperitoneal nodes are sampled or removed.

• Assign 38571 (… with bilateral total pelvic lymphadenectomy) if a bilateral total lymphadenectomy is performed and is medically necessary.

• Report 38572 (… with bilateral total pelvic lymphadenectomy and peri-aortic lymph node sampling (biopsy), single or multiple) if the surgeon performs a bilateral total lymphadenectomy and periaortic nodes are sampled, and both procedures are medically necessary.

• Use 38573 (… with bilateral total pelvic lymphadenectomy and peri-aortic lymph node sampling, peritoneal washings, peritoneal biopsy(ies), omentectomy, and diaphragmatic washings, including diaphragmatic and other serosal biopsy(ies), when performed) when one or multiple nodes are biopsied and total pelvic lymphadenectomy procedures are performed, and the procedures are medically necessary.

Remember This Expert Documentation Advice

Don’t forget to review the surgical report to determine which procedure the surgeon performed. If the documentation is unclear, create a dialogue with the provider who performed the procedure to make sure you report the appropriate CPT^® codes. Make sure the surgical note includes whether the laparoscopic or robotic-assisted approach was performed.

These articles should give you an understanding of the types of prostatectomies that surgeons can perform to treat their urology patients.

Series recap: Check out Part 1 of the series where Revenue Cycle Insider examined the subtotal and radical prostatectomy procedures with perineal approach. Then, read Part 2, which covers retropubic prostatectomy procedures with an open abdominal approach.

Stephanie N. Stinchcomb Storck, CPC, CPMA, CUC, CCS-P,
longtime urology coding expert, Summerfield, Florida