Urology Coding Alert

Question: One of our urologists performed a joint case with a general surgeon which involved removal of the patient’s bladder, prostate, anus, rectum, and partial sigmoid colon en bloc. They also performed an end proximal transverse colostomy and an ileal conduit. The diagnosis was locally advanced bladder carcinoma involving the entire pelvis. I’m thinking about reporting 51597, but not sure. What do you recommend?

New Jersey Subscriber

Answer: Based on the information you provide, the most appropriate code probably is 51597 (Pelvic exenteration, complete, for vesical, prostatic or urethral malignancy, with removal of bladder and ureteral transplantations, with or without hysterectomy and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof), as you suggest.

If the general surgeon helped with the urology part of the case and personally did part of the surgical procedure described by 51597 (such as the bowl resection and ileal conduit) and dictated his part, he should code 51597-62 (Two surgeons) to indicate his part as a co-surgeon.

The urologist should also bill as a co-surgeon with 51597-62 for performing the cystectomy and radical prostatectomy and assisting the general surgeon. The urologist should report/dictate what part of the procedure 51597 he personally performed.

Remember that when billing for Medicare, surgeons must be of separate specialties before you can bill them as co-surgeons. A copy of the operative reports should be able to show insurers which surgeon completed each portion of the procedure.