Urology Coding Alert

Question: In November, both of my urologists will start using the Da Vinci system for robot-assisted laparoscopic surgery. Is there a special code for robotic surgery? Do I need to add any modifiers?

California Subscriber

Answer: Report a robot-assisted laparoscopic procedure the same as you would a normal laparoscopic procedure. The AMA has been discussing adding a new CPT code for this type of surgery, but right now there is no special code. "In the meantime," states the American Urological Association Web site, "use the appropriate laparoscopic CPT procedure code."

Example: To bill for a laparoscopic radical prostatectomy using the Da Vinci system, simply use 55866 (Laparoscopy, surgical prostatectomy, retropubic radical, including nerve sparing).

Robotic surgery in itself doesn't require any modifiers. However, if the procedure takes a lot of extra time and the operative report outlines this time - for example, if there are extensive adhesions to remove - the AUA advises appending modifier -22 (Unusual procedural services) to reflect the extra work.

Disaster averted: Be sure to report an additional code - either 38570 (Laparoscopy, surgical; with retroperitoneal lymph node sampling [biopsy], single or multiple) or 38571 (... with bilateral total pelvic lymphadenectomy) - for any pelvic lymphadenectomy the urologist performs. Unlike the codes for open approaches, 55842 (Prostatectomy, retropubic radical, with or without nerve sparing; with lymph node biopsy[s] [limited pelvic lymphadenectomy]) and 55845 (... with bilateral pelvic lymphadenectomy, including external iliac, hypogastric, and obturator nodes), 55866 does not include lymphadenectomy.

Use the lymphadenectomy code, 38571, if a formal bilateral obturator fossa dissection is performed. Append modifier -52 (Reduced services) for a unilateral dissection, to show that the urologist did not perform the full bilateral service.