Urology Coding Alert

Question: How should we bill for a case done by two surgeons to repair a colovesical fistula? The general surgeon did a sigmoid colectomy, and our urologist completed a partial cystectomy to resect the bladder side of the fistula. The entire case was done robotically. How should this clinical scenario be coded?

Texas Subscriber

Answer: Since the entire procedure was performed laparoscopically (robotically), the appropriate code for the partial sigmoid colectomy would be 44204 (Laparoscopy, surgical; colectomy, partial, with anastomosis). Also include diagnosis N32.1 (Vesicointestinal fistula).

There are no specific CPT^® codes for a laparoscopic/robotic partial bladder resection, but a recent recommendation from the AUA (AUA Policy and Advocacy Brief, July 5, 2016) suggests using the standard procedure code 51555 (Cystectomy, partial; complicated [e.g., post-radiation, previous surgery, difficult location]) for the partial cystectomy performed robotically. Each surgeon would submit a separate claim for what he or she performed.

This clinical scenario does not fit billing as co-surgeons (i.e., each reporting the same CPT^® procedure code) with modifier 62 (Two surgeons).