Urology Coding Alert

Question: The physicians in my group have been coding the da Vinci procedure as a laparoscopic prostatectomy. Recently, however, we've started using unlisted-procedure code CPT 53899 . Would you clarify the proper way to report this procedure?


New Hampshire Subscriber


Answer: You should report a robot-assisted laparoscopic procedure the same that you would a normal laparoscopic procedure. For example, to bill for a laparoscopic radical prostatectomy using the da Vinci system, simply use CPT 55866 (Laparoscopy, surgical prostatectomy, retropubic radical, including nerve sparing).

Tip: Robotic surgery procedure codes themselves don't require explanatory modifiers. If your urologist spends a lot of extra time performing the procedure because of adhesions or other anatomical abnormalities and the operative report outlines this additional time, consider appending modifier 22 (Unusual procedural services) to the procedure code to reflect the extra work.
 
Bonus: Be sure to report an additional code--either 38570 (Laparoscopy, surgical; with retroperitoneal lymph node sampling [biopsy], single or multiple) or 38571 (... with bilateral total pelvic lymphadenectomy)--for any pelvic lymphadenectomy the urologist performs. Unlike the codes for open approaches, 55842 (Prostatectomy, retropubic radical, with or without nerve sparing; with lymph node biopsy[s] [limited pelvic lymphadenectomy]) and 55845 (... with bilateral pelvic lymphadenectomy, including external iliac, hypogastric, and obturator nodes), 55866 does not include lymphadenectomy.

Use 38571 if the urologist performs a formal bilateral obturator fossa dissection. For a unilateral dissection, you should report 38751 and append modifier 52 (Reduced services) to show that the urologist did not perform the full bilateral service.