Urology Coding Alert

Question: I need some help coding a laparoscopic simple prostatectomy with extensive lysis of adhesions. I was thinking the 55866 with modifier 52 and also modifier 22 for the adhesions. Is that correct?

West Virginia Subscriber

Answer: Since there is no CPT^® code for a simple robotic prostatectomy, you should use the unlisted code 55899 (Unlisted procedure, male genital system).

Here’s why: Code 55866 (Laparoscopy, surgical prostatectomy, retropubic radical, including nerve sparing, includes robotic assistance, when performed) is for a radical robotic prostatectomy and is not the proper code even though you wish to add modifier 52 (Reduced services). Modifier 52 does not change this code so that it represents a simple prostatectomy, which is a completely different prostatic operation.

Remember: Unlisted codes do not accept modifiers. You should, therefore, in your description of your operation, add the fact of the dense and excessive adhesions that required lysis. Bench mark this procedure with the open prostatectomy codes 55821 (Prostatectomy [including control of postoperative bleeding, vasectomy, meatotomy, urethral calibration and/or dilation, and internal urethrotomy]; suprapubic, subtotal, 1 or 2 stages) or 55831(… retropubic, subtotal). Then, add an extra fee for the lysis of adhesions. Request a fee somewhat more than either of the two above open prostatectomy codes. You will need to submit a detailed operative report and cover letter to the payer.