Urology Coding Alert

Question: My urologists are performing Da Vinci robotic laparoscopic vesicovaginal fistula repairs. How should I code these procedures?

Tennessee Subscriber

Answer: First, you should report CPT 51999 (Unlisted laparoscopic procedure, bladder) for the laparoscopic fistula repair. This is a bladder procedure performed abdominally so unlisted laparoscopic bladder procedure code 51999 is most appropriate.

If you are billing the service to a non-Medicare payer, you should consider also reporting S2900 (Surgical techniques requiring use of robotic surgical systems [list separately in addition to code for primary procedure]) since your urologists are using the Da Vinci system. 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.

Dx help: You should assign 619.0 (Urinary-genital tract fistula female) for the fistula between bladder and vagina. A vesicovaginal fistula (619.0) is an abnormal opening between the vagina and the bladder that allows urine to leak into the vagina.

Remember: Since your urologist performed these procedures laparoscopically, you should not bill an open code for the procedure -- 51900 (Closure of vesicovaginal fistula, abdominal approach) --- even though there is no specific laparoscopic code.

Pointer: Send a copy of the operative report and a covering letter along with your claim. The letter should explain the what, why, and how of the laparoscopic procedure in layman's terms. Compare the laparoscopic procedure to the open abdominal vesicovaginal repair (51900), stating that the services are similar in surgical technique, time to complete the procedure, anatomy, and prognosis, etc.