Urology Coding Alert

Question: I was just handed my first robotic cystectomy to code and need help. I cannot find a laparoscopic cystectomy code. Two urologists in our group worked together doing the robotic procedure and also performed an open ileal conduit. What coding would you suggest?

Michigan Subscriber

Answer: First, since there is no code for a laparoscopic cystectomy, use the unlisted laparoscopic bladder operation code 51999 (Unlisted laparoscopy procedure, bladder) for the robotic total cystectomy.

Additionally: If you're reporting this procedure to a non-Medicare carrier, you should also add code S2900 (Surgical techniques requiring use of robotic surgical system [list separately in addition to code for primary procedure]) for the urologist's robotic technology use.

Next: For the open ileal conduit and bilateral ureteroenterostomy, report 50820 (Ureteroileal conduit [ileal bladder], including intestine anastomosis [Bricker procedure]). Append modifier 50 (Bilateral procedure) indicating that the urologist performed two ureteroenterostomies. You should also attach modifier 51 (Multiple procedures) to 50820 to show that the urologist performed more than one procedure during the operative session.

Then: You should report 50605 (Ureterotomy for insertion of indwelling stent, all types) for the placement of universal single-J stents bilaterally during the open procedure. Be sure to attach modifiers 50 and 51 to 50605 as well as 50820.

Pitfall: If your urologist performed this procedure on a male patient, you should report two additional codes: 55866 (Laparoscopy, surgical prostatectomy, retropubic radical, including nerve sparing) for a radical robotic prostatectomy and 38571 (Laparoscopy, surgical; with bilateral total pelvic lymphadenectomy) for the bilateral robotic pelvic node resection. Append modifier 51 to each of these codes.