Urology Coding Alert

Question: Does CPT^® include a code for creation of an Ileal loop urinary diversion without a cystectomy? Every single code I’ve looked up includes the cystectomy. I queried the doctor and she confirmed that no cystectomy was done. It was a laparoscopic procedure. Do I just report 51595 with a 52 modifier or is there another code I should report instead?

Illinois Subscriber

Answer: Code 51595 (Cystectomy, complete, with ureteroileal conduit or sigmoid bladder, including intestine anastomosis; with bilateral pelvic lymphadenectomy, including external iliac, hypogastric, and obturator nodes) represents an open procedure, which would not be appropriate for your scenario even with appending modifier 52 (Reduced services). The current CPT^® code book does not include a laparoscopic code for the formation of an ileal loop, so your best option is to submit unlisted code 44238 (Unlisted laparoscopy procedure, intestine (except rectum)). Include detailed documentation from the operative report when you file the claim to explain what the urologist did.

Compare or bench mark the value of the laparoscopic procedure to 50820 (Ureteroileal conduit (ileal bladder), including intestine anastomosis (Bricker operation)), which has a total RVU value of 37.95 in a facility and when based on the 2020 national conversion factor of $36.0896, reimburses $1,369.60. You might be able to compare it to a higher-valued procedure if you can justify that the laparoscopic approach is more complex.