Wiki Robotic Simple Prostatectomy

[CBOLUC2687]

My question is regarding a Robotic SIMPLE Prostatectomy. There is only one robotic CPT code for a prostatectomy in the CPT book and that code reads:

55866- Laparoscopy, surgical prostatectomy, retropubic radical, including nerve sparing, includes robotic assistance when preformed.

Since a simple prostatectomy does not include everything listed in the description of CPT code 55866, I have been adding a 52 modifier for reduced services. Is this correct or should I be billing something different? My docs are worried we are missing out on money by adding a 52 modifier.

Any input will be greatly appreciated!

 

[Pam Warren]

I don't think there's a code for a simple lap prostatectomy? If there is (not my area of expertise), you can code that, and add the S2900 for robotic procedure performed. If there's no code for the simple prostatectomy, you'd have to code the radical with the -52.

 

[drewvinson23]

Here's an answer from an AAPC Urology Coding Alert from 2015; Volume 17, Number 9:

Question: What is the proper way to code a robotic-assist laparoscopic simple prostatectomy for BPH with bladder outlet obstruction? Most of my urologists are using unlisted 55899 and benchmarking 55866. However, it was brought to my attention by our auditing/education department that we should be benchmarking 55821 or 55831.
Idaho Subscriber
Answer: You are correct to report 55899 (Unlisted procedure, male genital system) for a robotic-assisted laparoscopic simple prostatectomy. However, 55866 (Laparoscopy, surgical prostatectomy, retropubic radical, including nerve sparing, includes robotic assistance, when performed) is not the code you should benchmark against. As you mentioned, 55821 (Prostatectomy (including control of postoperative bleeding, vasectomy, meatotomy, urethral calibration and/or dilation, and internal urethrotomy); suprapubic, subtotal, 1 or 2 stages) or 55831 (...retropubic, subtotal) are better options.
Use 55821 if your urologist is performing the laparoscopic prostatic enucleation through an open bladder approach. If he is using an incision in the prostatic capsule instead, use 55831. Check your surgeon’s documentation to determine the best code to use as your benchmark.

Report diagnosis code 600.01 (Hypertrophy ]benign] of prostate with urinary obstruction and other lower urinary tract symptoms [LUTS], [ICD-10: N40.1, Enlarged prostate with lower urinary tract symptoms]) for the benign prostatic hyperplasia (BPH) with bladder outlet obstruction (BOO) notation.

When using an unlisted CPT® code, bench marking it to a similar specific CPT® code enables a payer to determine a fee for the unlisted code using the bench marked coded procedure fee as a reference or guideline. An incorrect bench marked specific CPT® code may lead to a lesser reimbursement and loss of appropriate revenue for that unlisted procedure.

Drew Vinson
CPC
NW Urology

 

[drewvinson23]

And here is an updated post from the AAPC Urology Coding Alert from 8/11/16

Question: The urologist performed a DaVinci robotic-assisted simple suprapubic prostatectomy. Would this still qualify for 55866 with a reduction modifier 52, as this was a simple instead of a radical prostatectomy? I do not see another code for robot-assisted, and I am hoping to not have to use an Unlisted Procedure code.

Utah Subscriber

Answer: Following the new coding guidelines for laparoscopic cystectomy noted in an earlier discussion in this issue and extending the rule to other laparoscopic procedures without specific CPT® codes, report code 55821 (Prostatectomy [including control of postoperative bleeding, vasectomy, meatotomy, urethral calibration and/or dilation, and internal urethrotomy] suprapubic, subtotal, 1 or 2 stages). Note that this code lacks an approach vignette in its descriptive code definition. In other words, you may use this code to bill either an open or laparoscopic simple suprapubic prostatectomy using only 55821. Adding modifier 52 to code 55866 (Laparoscopy, surgical prostatectomy, retropubic radical, including nerve sparing, includes robotic assistance, when performed) is incorrect coding as you cannot change a code description or meaning of a procedure code by adding modifier 52 (Reduced services).

Drew Vinson
CPC
NW Urology