Urology Coding Alert

Question: How should we bill for a laparoscopic excision and closure of a colovesical fistula by two surgeons? Our urologist performed the bladder side of the procedure, excising bladder tissue due to localized necrosis, followed by a two-layer closure of the bladder. Our general surgeon laparoscopically excised a segment of the colon involved in the fistula, re-anastomosed the colon, and then instilled saline to check for evidence of leaks.

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Answer: Because there is no code for the laparoscopic bladder surgery and the partial cystectomy, you should report the service with CPT^® code 51999 (Unlisted laparoscopy procedure, bladder).

The surgeon should code 44204 (Laparoscopy, surgical; colectomy, partial, with anastomosis) for his part of the procedure.

Although you have indicated that the procedure involved two surgeons, you should not use modifier 62 (Two surgeons), because most payers will not accept pricing modifiers such as modifier 62 on unlisted procedure codes.

Do this: Because you need to indicate the price for an unlisted code, you should price the procedure based on the fee schedule corresponding to the open specific procedure. Setting a value at 125 percent of 51555 (Cystectomy, partial; complicated [eg post-radiation, previous surgery, difficult location]) would seem correct for the laparoscopic partial cystectomy performed by the urologist.