Robotic assisted surgery for the prostate
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Robotic Assisted Surgery for the Prostate. Coding Presented by Allison Tanksley, CPC. PSA-Prostate Specific Antigen. Medicare. Commercial Carriers. Diagnostic 84153 790.93 185 V10.46 599.70/599.71 See NCD for medically necessary diagnosis Screening G0103 V76.44

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Robotic Assisted Surgery for the Prostate

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Robotic assisted surgery for the prostate

Robotic Assisted Surgeryfor the Prostate

Coding Presented by

Allison Tanksley, CPC


Psa prostate specific antigen

PSA-Prostate Specific Antigen

Medicare

Commercial Carriers

Diagnostic

84153

790.93

185

V10.46

599.70/599.71

See NCD for medically necessary diagnosis

Screening

G0103

V76.44

Allowed annually-age 50 or older

Watch for eligibility

Diagnostic

84153

Screening

84153


Biopsy of prostate

Biopsy of Prostate

  • Needle or punch, single or multiple, any approach

  • CPT 55700-In Office

    • CPT 76942

    • CPT 76872

  • Covered by Carriers

  • Transperineal, stereotactic template guided saturation sampling, including imaging guidance

    • CPT 55706- Performed in a Surgical Setting (Usually ASC or outpatient hospital)

    • CPT 76872-26

  • Covered by most Carriers

    • NOT Regence

    • NOT Premera

  • Not done for the # of samplings, but for the approach-is not needle or punch


Additional diagnostic testing

Additional Diagnostic Testing

  • CT

  • MRI

  • Bone Scan

    • Screening-Not covered by Medicare for men

    • Must obtain Medicare ABN

    • Diagnostic-Reimbursable if patient has covered condition


Additional treatment options

Additional Treatment Options

  • Cryotherapy

  • Radiation Therapy

    • External Beam


Brachytherapy

Brachytherapy

  • 55875

    • Performed in a Surgical Setting (Usually ASC or outpatient hospital)

  • 76965-26

  • Radioactive Seeds

    • Billed by whoever purchased them (facility)


Brachytherapy1

Brachytherapy

Radiologic Tissue Marking

  • 55876

    • Performed in Office

  • 76942-59

  • 76873

  • A4648-implantable tissue marker; any type; each

    • Calypso Beacons or Gold Seed Markers


Androgen deprivation therapy

Androgen Deprivation Therapy

  • Lupron

    • Lowers the amount of testosterone made by the testicles

    • 96402

      • Medicare use 96372

    • J9217

      • Per 7.5 mg

  • Degarelix

    • used to reduce testosterone levels more quickly; does not have the initial flare tumor; used for advanced prostate cancer

    • 96402-ALL Carriers

    • J9155

      • Per mg


Prostatectomy

Prostatectomy

Traditional or Open

Laproscopic

55840 - Prostatectomy, retropubic radical, with or without nerve sparing

55866-Prostatectomy, retropubic radical, including nerve sparing, includes robotic assistance, when performed

38571-Bilateral total pelvic lymphadenectomy

51990-urethral suspension for stress incontinence


Cpt 51990

CPT 51990

Urethral suspension for stress incontinence

  • Difficulty in receiving reimbursement

  • Denials due to Diagnosis (ICD-9 185)

  • Previously a Female ONLY procedure code

  • Requiring Letter from Provider


Cpt assistant archives surgery male genital system q a march 2012

CPT Assistant Archives-Surgery: Male Genital System (Q&A) (March 2012)

March 2012 page 10b

Surgery: Male Genital System

Question: Would you please provide coding clarification for the following scenario: The urologist performs a robotic prostatectomy for the treatment of prostate cancer, and during the same session also performs a laparoscopic robotic Marshall-Marchetti-Krants (MMK) urethropexy procedure to prevent stress incontinence. How are these services reported?

Answer: The robotic prostectomy is reported with code 55866, Laparoscopy, surgical prostatectomy, retropubic radical, including nerve sparing, includes robotic assistance, when performed, AND the laparoscopic robotic MMK urethropexy is reported separately with code 51990, Lapraroscopy, surgical; urethral suspension for stress incontinence, OR code 51992, Laparoscopy, surgical; sling operation for stress incontinence (eg, fascia or synthetic).


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