Urology Coding Alert

Understand the differences between codes 55600 and 55650.

When your urologist carries out procedures on the seminal vesicles, it’s crucial to verify the specifics in the medical records, such as whether an incision or excision was performed. This key information will guide your selection of the appropriate medical code.

Continue reading to discover how to consistently submit error-free seminal vesicle claims in your medical practice.

Focus on 2 Codes for Seminal Vesicle Incision

Sometimes your urologist may perform a vesiculotomy, which is a surgical cut in the seminal vesicles. Their approach can be an incision either into the lower abdomen or the perineum between the anus and the scrotum.

When your urologist performs a vesiculotomy, you can either report 55600 (Vesiculotomy) or 55605 (Vesiculotomy; complicated).

Code 55600: Report 55600 if your provider performs a simple, uncomplicated vesiculotomy.

Code 55605: Report 55605 if your provider performs a complex dissection due to scar tissue in the area.

Remember: Codes 55600 and 55605 represent a unilateral service, meaning they are performed on one side. If your provider performs these procedures bilaterally, you should append modifier 50 (Bilateral procedure) or modifiers RT (Right side) or LT (Left side) to the code, depending upon your payer’s preference.

Turn to 1 Option for Vesiculectomy

In certain situations, your urologist may need to carry out a vesiculectomy, which involves the removal of one of the seminal vesicles. Typically, an excision is performed by your urologist to eliminate a calculus or other blockage, or due to a lesion or infection in the vesicles. The procedure can be approached either through the lower abdomen or the perineum. You should report a vesiculectomy with 55650 (Vesiculectomy, any approach), regardless of the approach.

Modifier alert: Like 55600 and 55605, 55650 represents a unilateral service, so you should append modifier 50 or modifiers RT or LT again depending upon your payer’s preference.

Be aware: Although the terms “vesiculectomy” and “vesiculotomy” may look very similar, they describe two very different types of procedures. A vesiculectomy refers to an excision of the seminal glands, while a vesiculotomy refers to an incision.

Look at This Real Coding Example Using 55650

Question: As a medical coder, I have a query about the application of 55650 during a laparoscopic robotic prostatectomy and laparoscopic lymphadenectomy. The urologist I work with normally bills 55866 (Laparoscopy, surgical prostatectomy, retropubic radical, including nerve sparing, includes robotic assistance, when performed), 38571 (Laparoscopy, surgical; with bilateral total pelvic lymphadenectomy), and 55650-50 for this procedure, with the documentation indicating the removal of the seminal vesicles along with the prostate and lymph node packets. However, another urologist only reports 55866 and 38571 for the same procedure, which also includes the removal of the seminal vesicles. I’m curious to know if the seminal vesiculectomy is normally included in the prostatectomy CPT^® code already?

Answer: The correct answer is to report all three CPT^® codes for the laparoscopic prostatectomy, laparoscopic lymphadenectomy, and seminal vesicle removal, according to Stephanie Stinchcomb Storck, CPC, CPMA, CUC, CCS-P, ACS-UR, longtime coder and consultant in Glen Burnie, Maryland. There is no Medicare National Correct Coding Initiative (NCCI) edit to prevent reporting of 55866, 38571 and 55650-50. Each code captures the work involved in all three procedures, all of which should be documented well in the surgical procedure operative report. Be advised that the codes will be subject to the multiple procedure reduction for Medicare. Commercial health plans may have their own edits and multiple procedure reduction in place.

Look to 55680 for Mullerian Duct Cyst Excision

In certain situations, your urologist might have to perform an excision of a Mullerian duct cyst, an abnormal structure in the seminal vesicles that remains from the

developmental stage before birth. In such scenarios, you should report 55680 (Excision of Mullerian duct cyst) for the excision of a Mullerian duct cyst. Your urologist may excise the cyst using a lower abdominal or perineal approach.

Mullerian duct cyst defined: The Mullerian duct normally regresses in utero, but it can sometimes leave a remnant that turns into a Mullerian duct cyst. A Mullerian duct cyst is considered a congenital abnormality. It is typically small and asymptomatic but can appear as a pelvic mass or cause obstructive and irritating urinary symptoms later on if left untreated. “It’s important that the urologist documents all findings in the operative report to capture this congenital malformation,” says Storck.