Coding Presented by Allison Tanksley, CPC Robotic Assisted Surgery for the Prostate

PSA-Prostate Specific Antigen Medicare Commercial Carriers Diagnostic V / See NCD for medically necessary diagnosis Screening G0103 V76.44 Allowed annually-age 50 or older Watch for eligibility Diagnostic Screening 84153

Biopsy of Prostate Needle or punch, single or multiple, any approach CPT In Office CPT CPT Covered by Carriers Transperineal, stereotactic template guided saturation sampling, including imaging guidance CPT Performed in a Surgical Setting (Usually ASC or outpatient hospital) CPT 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 Performed in a Surgical Setting (Usually ASC or outpatient hospital) Radioactive Seeds Billed by whoever purchased them (facility)

Brachytherapy Radiologic Tissue Marking Performed in Office 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 Medicare use 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 ALL Carriers J9155 Per mg

Prostatectomy Traditional or OpenLaproscopic Prostatectomy, retropubic radical, with or without nerve sparing Prostatectomy, retropubic radical, including nerve sparing, includes robotic assistance, when performed Bilateral total pelvic lymphadenectomy urethral suspension for stress incontinence

CPT 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).