Medicare Compliance & Reimbursement

Here's how to ensure your robotic-assist coding is living up to its potential

Myth: You can never get paid for robotic technology, such as the Da Vinci system, used with a prostatectomy and other procedures.

Reality: There's a new code to cover the robotic technology the doctor uses, S2900 (Surgical techniques requiring the use of robotic surgical systems [list separately in addition to the code for primary procedure]).

More and more physicians are using the Da Vinci system to aid with their prostatectomies. But obtaining the reimbursement your physician deserves will take some research--and some persistence.

Bad news: Medicare will never pay for S2900. S codes, found only in the HCPCS manual, are temporary national codes which Medicare never covers. But other payors, including some Medicaid programs, will cover S codes.

"It's a mixed bag" as to which payors recognize code S2900 and which ones don't, says Christy Shanley, CPC, billing manager for the University of California, Irvine Dept. of Urology.

She's reported S2900 in addition to codes such as prostatectomy code 55866, nephrectomy code 50545, bilateral total pelvic lymphadnecotomy code 38571 and colpopexy code 57425. She's received payment for both codes by several HMOs on first submission, with no appeals necessary.

Some private payors who have paid on S2900 include Aetna, United Healthcare, Blue Cross/ Blue Shield of Florida, and Keystone Healthcare in Pennsylvania, says Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology at State University of New York, Stony Brook. You can expect payments ranging from $300 to over $1000 for S2900, he adds.

If your payor recognizes the S code, you should report the laparoscopic procedure code first and then S2900.

You don't need a modifier because S2900 is an add-on code.

Be proactive: "For private non-Medicare carriers, when you're using robotic surgical technology, report S2900 to carriers and keep a record of which ones pay and which ones do not pay," Ferragamo suggests. Try appealing the first denials from a payor.

Tip: Avoid denials by finding out whether the payor wants S2900 or an unlisted code before your urologist performs the surgery. "When we request authorization for surgery, we include this code too," Shanley says.

Bottom line: "As urologists increasingly use this technology, we'll see more payors recognizing this code and coders should call payor attention to this code," Ferragamo says.

You should tell your carriers that "there are insurances that do pay for this, noting the increased skill and training the urologist needs to use the robotics," he adds.