Robotic Assisted Surgery for the Prostate

1. Robotic Assisted Surgeryfor the Prostate Coding Presented by Allison Tanksley, CPC

2. 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

3. 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

4. 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

5. Additional Treatment Options • Cryotherapy • Radiation Therapy • External Beam

6. Brachytherapy • 55875 • Performed in a Surgical Setting (Usually ASC or outpatient hospital) • 76965-26 • Radioactive Seeds • Billed by whoever purchased them (facility)

7. Brachytherapy Radiologic Tissue Marking • 55876 • Performed in Office • 76942-59 • 76873 • A4648-implantable tissue marker; any type; each • Calypso Beacons or Gold Seed Markers

8. 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

9. 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

10. 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

11. 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).