Urology Coding Alert

Question: How should I code a radical cystoprostatectomy with bilateral pelvic lymphadenectomy, gastrostomy tube placement, and ileal conduit? 
     
Kentucky Subscriber

Answer: You should report 51595 (Cystectomy, complete, with ureteroileal conduit or sigmoid bladder including intestine anastomosis; with bilateral pelvic lymphadenectomy, including external iliac, hypogastric, and obturator nodes) for the complete cystectomy, node dissection and ileal conduit; 55840 for the radical prostatectomy (nodes removed with the above code); and 43830 (Gastrostomy, open; without construction of gastric tube [e.g., Stamm procedure] [separate procedure]) for the feeding gastrostomy.
 
If this is a Medicare patient, Medicare will add modifier -51 (Multiple procedures) to the proper codes. None of these procedures share a "base code."
 
If two surgeons were involved in the procedure, use modifier -62 (Two surgeons), but make sure each surgeon thoroughly documents and dictates his or her separate portion of the procedure as well as indicating what the other physician did.