Urology Coding Alert

Question: What is the proper way to code a robotic-assist laparoscopic simple prostatectomy for BPH with bladder outlet obstruction?  Most of my urologists are using unlisted 55899 and benchmarking 55866.  However, it was brought to my attention by our auditing/education department that we should be benchmarking 55821 or 55831.

Idaho Subscriber

Answer: You are correct to report 55899 (Unlisted procedure, male genital system) for a robotic-assisted laparoscopic simple prostatectomy. However, 55866 (Laparoscopy, surgical prostatectomy, retropubic radical, including nerve sparing, includes robotic assistance, when performed) is not the code you should benchmark against. As you mentioned, 55821 (Prostatectomy (including control of postoperative bleeding, vasectomy, meatotomy, urethral calibration and/or dilation, and internal urethrotomy); suprapubic, subtotal, 1 or 2 stages) or 55831 (...retropubic, subtotal) are better options. 

Use 55821 if your urologist is performing the laparoscopic prostatic enucleation through an open bladder approach. If he is using an incision in the prostatic capsule instead, use 55831. Check your surgeon’s documentation to determine the best code to use as your benchmark.

Report diagnosis code 600.01 (Hypertrophy ]benign] of prostate with urinary obstruction and other lower urinary tract symptoms [LUTS], [ICD-10: N40.1, Enlarged prostate with lower urinary tract symptoms]) for the benign prostatic hyperplasia (BPH) with bladder outlet obstruction (BOO) notation.

When using an unlisted CPT^® code, bench marking it to a similar specific CPT^® code enables a payer to determine a fee for the unlisted code using the bench marked coded procedure fee as a reference or guideline. An incorrect bench marked specific CPT^® code may lead to a lesser reimbursement and loss of appropriate revenue for that unlisted procedure.