Urology Coding Alert

Question: The patient underwent laparoscopic radical cystectomy with ileal conduit diversion and extended lymph node dissection. The uterus, cervix, tubes, ovaries, and anterior wall of the vagina were removed en bloc with the specimen. Do we bill cystectomy and hysterectomy?

Oregon Subscriber

Answer: This is difficult to confirm without seeing the operative note, but it sounds like the surgeon completed a laparoscopic radical cystectomy, an extended pelvic node resection, an ileal conduit diversion and a total hysterectomy with tubes and ovaries.

Since there is no CPT^® code for a laparoscopic radical cystectomy, bill procedure code 51999 (Unlisted laparoscopic procedure, bladder) and benchmark this unlisted code to CPT^® code 51570 (Cystectomy complete; [(separate procedure]).

Since there is no laparoscopic CPT^® code for construction of an ileal conduit, report 44238 (Unlisted laparoscopic procedure, intestine [except rectum]) and benchmark this unlisted code to 50820 (Ureteroileal conduit [ileal bladder], including intestine anastomosis [Bricker operation]). Also bill code 58571 (Laparoscopy, surgical, with total hysterectomy, for uterus 250 gm or less; with removal of tube[s] and/or ovary[s]). To complete the claim, report code 38572 (Laparoscopy, surgical; with bilateral total pelvic lymphadenectomy and peri-aortic lymph node sampling [biopsy], single or multiple) for the extended node dissection.

The AUA has recently suggested in its AUA Policy and Advocacy Brief, July 5, 2016, that since there is no surgical approach indicated in the definition, bill CPT^® code 51590 (Cystectomy, complete, with ureteroileal conduit...including intestine anastomosis) in place of the two unlisted laparoscopic codes noted above for the radical cystectomy and ileal conduit.

Also note: Verify that the surgeon has sufficient documentation supporting separate billing for each of these services.