Urology Coding Alert

Question: My urologist performed a retropubic prostatectomy including the external iliac and hypogastric node dissection. Should I report CPT 55842-22 to indicate that the urologist performed more than the standard prostatectomy?

Virginia Subscriber

Answer: Your confusion stems from the fact that there is no code to represent the two services your urologist performed with the prostatectomy: external iliac node dissection and hypogastric node dissection.
 
Instead of reporting 55842 (Prostatectomy, retropubic radical, with or without nerve sparing; with lymph node biopsy[s] [limited pelvic lymphadenectomy]) with modifier -22 (Unusual procedural services), report the code that more closely identifies the services your urologist performed: 55845 (... with bilateral pelvic lympha-denectomy, including external iliac, hypogastric, and obturator nodes). The AUA has indicated this CPT code to describe a radical retropubic prostatectomy with bilateral  lymph node resection of various extent and degree.
 
If the urologist performs a bilateral dissection of any nodes with the radical prostatectomy, report 55845. Apply modifier -52 (Reduced services) only if a unilateral dissection is accomplished. However, if he just samples nodes and does not perform a true dissection, you should report 55482.