# I got introuble by the boss when I billed out 51595 please help me clear this up!!



## coding2244 (Apr 22, 2013)

*urology question*

two surgeons


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## Kelly_Mayumi (Apr 26, 2013)

I see 51999, 55866 for the first surgeon and 50820 for the second surgeon.


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## mitchellde (Apr 28, 2013)

janetjanuary said:


> Good Morning,
> 
> I have a situation in where I have two surgeons who  performed a procedure:
> Robotic assisted radical cystoprostatectomy with pelvic lymph node dissection.  An ileal conduit urinary diversion.  Please make note that Dr. Matthew Sand was the primary surgeon for the ileal conduit urinary diversion.
> ...


It dismays me that your manager chose to demote your rather than provide helpful instruction for the correct codes.
This was not an open procedure which is where your logic took a bad turn.  Also there is no one code that will combine the bladder excision and the prostate excision.  When you break it down into the separate parts you have a code for the robotic assisted laparoscopic prostatectomy which is the 55866, and then you are left with the cytectomy and lymph node disection for which there is no code, I would not use a 22 modifier in this case but I would use the 51999 and compare it to 51575.  
for the second surgery again there is no laparoscopic code for the ileal conduit diversion so you will need to use the 50949 and compare it to the 50820.  
that is how I would have coded these notes.
A handy book to have in the surgical field is the "Coders Desk Reference for Procedures" by Ingenix.  It can help you rock thru coding surgeries.
However when you have a note that indicates laproscopic approach you do not code it as an open procedure, it you have to use an unlisted then do so but compare it to the open procedure code you would have used.


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## ybarde (Sep 8, 2015)

*CPT code for revision of Ileal loop conduit diversion*

My doctor did below procedure. Ileal loop conduit was already done in 2014 and now doctor did revision of that in 2015. Please help me for this.

PROCEDURE:    Revision of ileal loop conduit diversion with repositioning  on anterior  abdominal wall.

POSTOPERATIVE    DIAGNOSIS:     History of neurogenic bladder with retracted  ileal loop conduit.

PROCEDURE IN DETAIL: The patient was taken to the OR, laid in a supine position. Appropriate  anesthesia was administered.  Her abdomen was prepped and draped in a standard surgical fashion. A circumferential  incision was made around the original ileal loop conduit.  It appeared to have been retracted,  and there was a large dimple in the area, and due to patient's body habitus the phalange for the urostomy bag was not adherent.  After dissecting out with meticulous dissection the conduit through  the subcutaneous tissue, the fascia was entered, and the rectus muscle was exposed, and the conduit was dissected around the rectus muscle to the fascia level. The fascia was opened, and this allowed for freeing of the ileal loop further  to allow mobilization  to its new site. Next, after further  pulling the loop out, it was secured to the fascia with some interrupted  2-0 Vicryl suture. The previously marked site for the new conduit stoma was then excised circumferentially,   and some of the subcutaneous tissue was dissected. Next,
the dissection was carried down to the fascia and then the ileal loop was tunneled to the new site and brought up. After trimming  the edges of the ileal loop, adequate hemostasis was ensured, and then it was secured to the skin in the usual fashion using 2-0 Vicryl suture  in an interrupted fashion. A nice rosebud conduit was noted. Adequate hemostasis was ensured. The urostomy bag and phalange were appropriately  connected and placed on the anterior  abdominal wall,  and it appeared to be adherent  nicely with no abnormalities.

The previous incision was  first irrigated  with antibiotic  irrigation  and then a  large flat JP drain was brought out subcutaneously.  The incision was closed first by reapproximating  the subcutaneous tissue with 2-0 Vicryl suture  in a continuous fashion and then the skin with staple clips. Sterile dressings were applied. The needle, instrument,  and sponge counts were correct. The patient was extubated  and transferred  to the recovery room in stable condition.

Thanks in advance!
Yogesh


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## JEYCPC (Sep 10, 2015)

Look at CPT 44314.


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## ybarde (Sep 16, 2015)

But my doctor is urologist.
Please help!


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## nateich (Sep 17, 2015)

Yogesh, the code you should be looking at is 44314, as JEYCPC posted.  

If you are still unsure, take your CPT book to your Dr and tell him/her that you need their assistance with the OP note and show this code and ask if you are on the right track.


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## JEYCPC (Sep 21, 2015)

ybarde said:


> But my doctor is urologist.
> Please help!



You must think outside the box.  the 50000 codes are mostly where Urologists look.  But there are many codes all over the CPT book that are possibilities.


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