Urology Coding Alert

Question: A patient had a squamous cell cancer of the urethra that spread to the prostate. Intraoperatively, the surgeons found they could not spare the penis because of the spread of cancer. They performed a radical penectomy, a urethrectomy, a prostatectomy, an ileovesical cutaneous diversion, and a bilateral pelvic lymphadenectomy. The ileum was attached to the bladder neck - the ureters were not reimplanted into the ileum. How should I code this?

Maine Subscriber

Answer: Use 55845 (Prostatectomy, retropubic radical, with or without nerve sparing; with bilateral pelvic lymphadenectomy, including external iliac, hypogastric, and obturator nodes) for the radical prostatectomy, including the node resection. Report 54125 (Amputation of penis; complete) for the complete amputation of the penis. Although CPT 54125 and CPT 53215(Urethrectomy, total, including cystostomy; male) are not bundled, the urethrectomy would be included in the penectomy and you should not charge them separately.

Code 51960-52 (Enterocystoplasty, including intestinal anastomosis; reduced services) is the best CPT Code to report for the ileovesical diversion. The code represents the anastomosis of the bowel to the bladder - in this case to the bladder neck. Add modifier -52 to indicate decreased work, because the surgeons did not first detubularize the bowel before the enterovesical anastomosis.

Report 44310 (Ileostomy or jejunostomy, non-tube [separate procedure]) for the formulation of the ileostomy.