Urology Coding Alert

Question: I read the article in Vol. 10, No. 2 of Urology Coding Alert regarding coding for robotic-assisted procedures. I have two questions about the procedures: Is it a requirement that facilities use code S2900 whenever a physician performs a robotic urology procedure? If so, when did the use of this code become a requirement?

New York Subscriber

Answer: Code S2900 (Surgical techniques requiring use of robotic surgical systems [list separately in addition to code for primary procedure]) is not a requirement for billing. In fact, Medicare will not reimburse for S codes. But many private payers, such as the Blues, may reimburse the physician for this code indicating his use of robotic technology.

What it means to you: Experts suggest not billing Medicare for this code, but billing non-Medicare carriers to find out which carriers do pay and which ones do not.

For private non-Medicare carriers, when the urologist uses robotic surgical technology, report S2900 and keep a record of which carriers pay and which ones do not pay. Try appealing the first denials from a payer, explaining the existence of S2900 and that other payers are reimbursing for this HCPCS code. When you know that a payer, like Medicare, won't accept S2900, report only the main procedure code.

Example: Your urologist performs a laparoscopic pyeloplasty using the da Vinci surgical robotic system. For Medicare, you should report 50544 (Laparoscopy, surgical; pyeloplasty) alone. For private payers that accept S2900, you should report 50544 and S2900.