Urology Coding Alert

Question: How should I code for the following: laparoscopic radical prostatectomy, cystoscopy with direct vision internal urethrotomy, bilateral vesiculectomies, and cystoplasty all in one procedure? Our physician continues to want to bill bilateral vesiculectomies and cystoplasty with the radical prostatectomy and we are looking for some guidance on the issue. Our office has been billing the 55866 without the vesiculectomies. Who is correct?

Pennsylvania Subscriber

Answer: You are correct. Reporting 55866 (Laparoscopy, surgical prostatectomy, retropubic radical, including nerve sparing, includes robotic assistance, when performed) is appropriate. The laparoscopic radical prostatectomy in addition to the complete removal of the prostate gland includes the removal of the seminal vesicles (vesiculectomies) and the reconstruction of the bladder neck, cystoplasty, (the anastomosis of the bulbous urethra to the bladder). These two separate procedures are integral parts of the whole procedure and should not be billed separately.

You should code for the direct vision urethrotomy with 52276 (Cystourethroscopy with direct vision internal urethrotomy). Diagnosis for this procedure should be the appropriate urethral stricture code (598.00-598.9).