Urology Coding Alert

Here’s the latest on how to potentially handle those claims.

The American Urological Association (AUA) recently shared information in its Policy and Advocacy Brief of July 5, 2016, about a new approach for coding the various versions of laparoscopic cystectomy. The Association stated that it reviewed the currently available CPT^® codes for cystectomy (51550-51596) in response to member inquiries.

Current situation: CPT^® does not include a code specific for a laparoscopic radical cystectomy. In the past, coders often were directed to report 51999 (Unlisted laparoscopy procedure, bladder) and benchmark to the “open” CPT^® codes.

The latest: The AUA’s notice states that it’s CRC (Coding and Reimbursement Committee) “determined that these codes are not approach dependent. Therefore, the CRC has determined that the current CPT^® codes for cystectomy be reported whether the approach is open or laparoscopic.”

Possible explanation: “Unlike nephrectomy where there are separate and unique open and laparoscopic codes – and where each has its own vignette that describes the open or laparoscopic approach – the original description for cystectomy did not include a vignette that described the surgical approach, and one has not been added,” explains Jonathan Rubenstein, MD, of Chesapeake Urology in Baltimore. “When laparoscopic cystectomy was originally being performed, an ‘unlisted’ code was suggested for coding purposes to differentiate it from an open procedure, and payment was appropriate.

“However, there had been rumors that some insurers have significantly cut reimbursement for cystectomy when using an ‘unlisted’ code,” or do not recognize “unlisted” codes at all in their coding modules. Rubenstein continues, “yet significant work is being done. Since no vignette exists, when performing a laparoscopic/robotic cystectomy, the cystectomy codes can and should be used as appropriate.”

Those codes you may choose include:

• 51550 – Cystectomy, partial; simple
• 51555 – … complicated (e.g., post radiation, previous surgery, difficult location)
• 51565 – … with reimplantation of ureter(s) into bladder (ureteroneocystostomy)
• 51570 – Cystectomy, complete; (separate procedure)
• 51575 – … with bilateral pelvic lymphadenectomy, including external iliac, hypogastric, and obturator nodes
• 51580 – Cystectomy, complete, with ureterosigmoidostomy or ureterocutaneous transplantations
• 51585 – … with bilateral pelvic lymphadenectomy, including external iliac, hypogastric, and obturator nodes
• 51590 – Cystectomy, complete, with ureteroileal conduit or sigmoid bladder, including intestine anastomosis
• 51595 – … with bilateral pelvic lymphadenectomy, including external iliac, hypogastric, and obturator nodes
• 51596 – Cystectomy, complete, with continent diversion, any open technique, using any segment of small and/or large intestine to construct neobladder.

As seen from the above list of codes, the CRC also included CPT^® code 51596 in its list of billable cystectomy codes for coding a laparoscopic/robotic cystectomy. However, this code includes the phrase “any open technique” which indicates the approach for this procedure as an open procedure. Because of this, code 51596 should not be included as proper coding for a laparoscopic/robotic cystectomy and construction of a neobladder, says Michael A. Ferragamo, MD, FACS, clinical assistant professor at the State University of New York at Stony Brook.

“For the latter, continue to use code 51999 (Unlisted laparoscopy procedure, bladder) for the laparoscopic cystectomy and 44238 (Unlisted laparoscopy procedure, intestine [except rectum]) for the laparoscopic construction of the neobladder, Ferragamo says.