Robotic Assisted Surgery
for the Prostate
Coding Presented by
Allison Tanksley, CPC
PSA-Prostate Specific Antigen
Medicare
 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
Commercial Carriers
 Diagnostic
 84153
 Screening
 84153
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
 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
 Cryotherapy
 Radiation Therapy
 External Beam
Brachytherapy
 55875
 Performed in a Surgical Setting (Usually ASC or
outpatient hospital)
 76965-26
 Radioactive Seeds
 Billed by whoever purchased them (facility)
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
 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
Traditional or Open
Laproscopic
 55866-Prostatectomy,
 55840 - Prostatectomy,
retropubic radical, with
or without nerve
sparing
retropubic radical,
including nerve sparing,
includes robotic
assistance, when
performed
 38571-Bilateral total
pelvic lymphadenectomy
 51990-urethral
suspension for stress
incontinence
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)
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).