Wiki ROBOTIC ASSISTED (radical) PROSTATECTOMY W PELVIC NODE REMOVAL?? +38571 OR BUNDLED??

[JenBrz]

Hello, patient had robotic assisted radical prostatectomy and pelvic lymph node dissection op note reads:

"We performed a bilateral pelvic lymph node dissection. Borders of our dissection included the pubic bone, the external iliac vein, the pelvic sidewall, and the bifurcation of the iliac vessels, and the obturator nerve. We had adequate node packets bilaterally."

Is this sufficient to add 38571 to claim? Definition of 38571 says it is for "total" and doc only removed 10 nodes not all nodes, according to path reports (4 on left, and 6 on right).

Definition of 55866 mentions "radical" and AAPC Codify explains the "radical" as Radical resection: Surgical removal of a structure to include its vascular supply, associated lymph nodes, and a sufficient margin of surrounding tissues, especially around a tumor, to ensure that all diseased tissue is removed.

Any advice is appreciated, I am hitting dead ends on AAPC, Google, and CPT Assist

 

[daniel]

I'd query the provider, is this simple 55867 or Radical 55866. What ever the physician clarifies on, I'd recommend they state simple vs radical in the title of the record.
CPT 38571 seems fine, based on bilateral mentioned.

 

[JenBrz]

I'd query the provider, is this simple 55867 or Radical 55866. What ever the physician clarifies on, I'd recommend they state simple vs radical in the title of the record.
CPT 38571 seems fine, based on bilateral mentioned.

Hi Daniel, thanks for the reply. The procedure was radical, not simple. I forgot to put that in the post, but have edited to add now. I guess that is what I am wondering, because it was radical, doesn't that include removing some lymph nodes?

I am also leaning towards using only 55866 because when I look up the "open" version of what he did in Codify, which is 55845, it says for laparoscopic retro to use 55866, see pic below. That little blurb is not populating for 55842 or 55840

 

[daniel]

Hi. I'd stick with 55866 + 38571 with this additional information provided.

Note; he/she saying: bilateral pelvic lymph node dissection. Borders of our dissection included the pubic bone, the external iliac vein, the pelvic sidewall, and the bifurcation of the iliac vessels, and the obturator nerve We had adequate node packets bilaterally." This is enough for me.

 

[JenBrz]

Hi. I'd stick with 55866 + 38571 with this additional information provided.

Note; he/she saying: bilateral pelvic lymph node dissection. Borders of our dissection included the pubic bone, the external iliac vein, the pelvic sidewall, and the bifurcation of the iliac vessels, and the obturator nerve We had adequate node packets bilaterally." This is enough for me.

Hi Daniel, so I did end up asking the doctor and he said the same thing about the borders. I guess what I am wondering is, is it the borders that make it "total" ? I did ask the doctor this as well, but he has not responded. I guess I am wondering why the lymph node removal is not included in the main procedure if it is "radical"?

 

[daniel]

pelvic lymph nodes are not directly surrounding the prostate or part of the typical surgical removal of the gland.

 

[JenBrz]

Hi Daniel, appreciate the input, but I am still wondering how that is the correct answer, is it because the lymph nodes are done in a "template"? I am trying to figure out the "why" to how the report supports a "total" procedure. Not saying you are wrong but I do not understand it at all LOL

 

[daniel]

Great question,


I think I see what your doing, you’re trying to cross walk 55845 to 55866.

I can’t speak to the clinical aspect, but the following is how you’d code these.

If the provided states Total pelvic lymphadenectomy, and the path reflects the same. I’d add CPT 38571, I wouldn’t get too deep into the weeds of counting lymph nodes.

Google CPT 55866 + 38571, you’ll find a sea of information.

I hope this helps.





Open Radical prostatectomy code range.

CPT 55840;Prostatectomy, retropubic radical, with or without nerve sparing;

CPT 55842; with or without nerve sparing; with lymph node biopsy(s) (limited pelvic lymphadenectomy)

CPT 55845; with or without nerve sparing; with bilateral pelvic lymphadenectomy, including external iliac, hypogastric, and obturator nodes


Laparoscopic radical prostatectomy


55866; Laparoscopy, surgical prostatectomy, retropubic radical, including nerve sparing, includes robotic assistance, when performed


Laparoscopic radical prostatectomy with bilateral total pelvic lymphadenectomy



55866; Laparoscopy, surgical prostatectomy, retropubic radical, including nerve sparing, includes robotic assistance, when performed

38571; Laparoscopy, surgical; with bilateral total pelvic lymphadenectomy