Urology Coding Alert

Question: When my urologist performs a robotic-assisted laparoscopic radical cystoprostatectomy, bilateral pelvic lymph node dissection, and then an open ileal conduit urinary diversion, what codes should I report?

California Subscriber

Answer: For the laparoscopic procedures, report three laparoscopic codes. First, since there is no code for a laparoscopic radical cystectomy, use the 2006 new unlisted laparoscopic bladder operation code 51999 (Unlisted laparoscopy procedure, bladder). 
 
Append modifier 22 (Unusual procedural services) to indicate to the carrier that the physician had to perform more work than the procedure usually requires.
 
Next, submit 55866 (Laparoscopy, surgical prostatectomy, retropubic radical, including nerve sparing) for the radical prostatectomy.
 
Append modifier 51 (Multiple procedures) for non-Medicare carriers to indicate that the urologist performed more than one procedure during the same session.
 
You should then also report 38571-51 (Laparoscopy, surgical; with bilateral total pelvic lymphadenectomy) for the bilateral pelvic node resection whether the urologist did a full bilateral pelvic dissection or only a bilateral obturator fossa dissection. If he only performed a unilateral dissection, report 38571-52-51, using modifier 52 (Reduced services) to indicate the reduced service of only a unilateral procedure. 
 
The key: Be sure to submit documentation for the unlisted-procedure code (51999). You should do this either using the notepad for an electronically submitted claim for carriers such as Medicare, or using a paper submission providing a copy of the operative report and a short covering letter explaining in layman's terms what the urologist did and why.
 
It may also be helpful for correct payment to cross-reference code 51570 (Cystectomy, complete; [separate procedure]) as the open procedure equivalent code. Hopefully the payer will allow a higher payment for the laparoscopic procedure than it would for the open procedure.
 
For the open abdominal part of the procedure, the construction of the ileal conduit, report 50820 (Ureteroileal conduit [ileal bladder], including intestine anastomosis [Bricker procedure]) with modifier 50 (Bilateral procedure) indicating that the urologist performed two ureteroneoenterostomies.
 
If he also stented the ureteroneoenterostomies with single universal J stents, also report 50605-50 (Ureterotomy for insertion of indwelling stent, all types) for the bilateral stents.