Urology Coding Alert
Work of 51595 Includes a Bilateral Pelvic Lymphadenectomy
Question: My physician performed a complete cystectomy for which I know we can file with 51595. I think we should also be able to include modifier 22 due to adhesions the patient has from previous surgeries. My physician wants to also bill for extended node dissection during the surgery and feels this should be separately reimbursable. Is that allowed?
Wisconsin Subscriber
Answer: Code 51595 (Cystectomy, complete, with ureteroileal conduit or sigmoid bladder, including intestine anastomosis; with bilateral pelvic lymphadenectomy, including external iliac, hypogastric, and obturator nodes) includes the bilateral pelvic lymphadenectomy, for which you cannot bill separately.
However, if the node resection extended out of the pelvis including intra-abdominal nodes at the aortic and vena caval levels, you may consider also billing the add-on code 38747 (Abdominal lymphadenectomy, regional, including celiac, gastric, portal, peripancreatic, with or without para-aortic and vena caval nodes [List separately in addition to code for primary procedure]).
Plus: If the lysis of adhesions prolonged the operation at least 25 to 30 percent longer than the normal performance time for this procedure, you may add modifier 22 (Increased procedural service) for this extra effort and time needed for the lysis of adhesions.
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