Urology Coding Alert

Question: I reported S2900 to a private payer for a robotic-assisted laparoscopic prostatectomy. The payer denied the S2900, but payment had been made in the past. Am I doing something wrong?

Answer: You need to update your coding for 2011. "The laparoscopic prostatectomy code (55866, Laparoscopy, surgical prostatectomy, retropubic radical, including nerve sparing, includes robotic assistance, when performed) now includes the use of robotic assistance, if used," explains Karla Dickerson, billing and reimbursement coordinator at Salina Urology Associates in Kansas. Therefore, it is no longer applicable or necessary to bill S2900 (Surgical techniques requiring use of robotic surgical system [list separately in addition to code for primary procedure]) in combination with the prostatectomy. It is clearly stated in the descriptor for 55866 that robotic assistance is now included in this CPT code.

However, you may wish to add S2900 when billing for other robotic-assisted laparoscopic procedures. For example, "I continue to use S2900 if the robot is used for pelvic lymph node excision (38571, Laparoscopy, surgical; with bilateral total pelvic lymphadenectomy)," Dickerson says.

Remember: Medicare doesn't recognize and therefore, does not reimburse for S2900. Presently, most private payers also follow this policy.

"The majority of commercial companies did not pay for this code in 2010, and I anticipate the same in 2011," Dickerson explains.