Urology Coding Alert

Question: The urologist performed a laparoscopic bladder diverticulum. What is the best way to report this procedure?

Texas Subscriber

Answer: There is no specific CPT Code for a laparoscopic bladder diverticulectomy. Therefore, you should use the unlisted bladder laparoscopic CPT 51999 (Unlisted laparoscopy procedure, bladder).

Benchmark this unlisted code with the open CPT code for bladder diverticulectomy (51525, Cystotomy; for excision of bladder diverticulum, single or multiple [separate procedure]).

Reason: An insurer will decide to pay an unlisted-procedure claim by comparing your procedure description to a similar, listed procedure with an established reimbursement value. Rather than leave it up to the insurer to determine which code is the "next closest," you should explicitly make reference to the nearest equivalent listed procedure. After all, the treating physician is best equipped to make this determination. You should also note the specific ways that the unlisted procedure differs from the next-closest listed procedure.

Essential: Send your payer full documentation of what your urologist did and why, including a detailed operative report and a covering letter explaining the operation with all of the above suggestions clearly documented. You should also charge a fee for your services of 20 to 30 percent more than the fees associated with the open diverticulectomy code.