Urology Coding Alert

Question: The patient had robotic assisted lap radical cystectomy with pelvic exenteration, lap bilateral pelvic lymph node dissection, and open ileal conduit. Should I report 51999 (Unlisted laparoscopy procedure, bladder), 58571 (Laparoscopy, surgical, with total hysterectomy, for uterus 250 g or less; with removal of tube(s) and/or ovary(s)), and 50820 (Ureteroileal conduit (ileal bladder), including intestine anastomosis (Bricker operation))? Or should I report 51597 (Pelvic exenteration, complete, for vesical, prostatic or urethral malignancy, with removal of bladder and ureteral transplantations, with or without hysterectomy and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof)?

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Answer: A true pelvic exenteration also includes removal of the bladder, removal of the uterus, tubes and ovaries as well as removal of the anus, rectum, and part of the sigmoid colon (the latter not reported); therefore, for this case as reported above you should not code for a total exenteration, as the colon, rectum, and anus resections were not performed, but you should report the following codes on your claim:

• 51999 for the laparoscopic cystectomy and benchmark to 51570 (Cystectomy, complete; (separate procedure))
• 58571 (Laparoscopy, surgical, with total hysterectomy, for uterus 250 g or less; with removal of tube(s) and/or ovary(s))
• 38571 (Laparoscopy, surgical; with bilateral total pelvic lymphadenectomy) for the laparoscopic pelvic node resection
• 50820-50 (Bilateral procedure) for the open ileal conduit formation.