For CPT 55866, it is typical to remove the seminal vesicles as part of procedure.
I am a coder and have a question regarding the use of Current Procedural Terminology (CPT) code 55650, billed during a laparoscopic robotic prostatectomy. I have one urologist who consistently bills CPT codes 55866, 38571, and also 55650-50 for this procedure, and whose documentation describes removing the seminal vesicles along with the prostate and lymph node packets. However, I have another urologist who only reports CPT 55866 and 38571 for the same work, including removal of the seminal vesicles. So I’m wondering if the seminal vesiculectomy is sort of “built in” to the prostatectomy CPT code.
You are correct: Seminal vesiculectomy is sort of built in to that code. To understand why, we need to learn how codes are valued.
Per the American Medical Association (AMA):
"Once new codes are created, or older codes are updated, the Centers for Medicare & Medicaid Services (CMS) assigns a value to each code, which determines the payments for that particular service under Medicare. To make sure physicians have a say in this process, the AMA created the Relative Value Scale Update Committee (RUC), a volunteer group of 31 physicians and health care professionals with input from 300 health care experts that represent each sector of medicine. Specialty societies survey their members and make recommendations to the RUC based on their areas of expertise."1
When a code is presented to be valued, a vignette is created that describes the typical procedure that is performed. That vignette is included in the survey. The survey responses are then reported to the RUC.
So for a CPT code such as 55866 (laparoscopy, surgical prostatectomy, retropubic radical, including nerve sparing, includes robotic assistance, when performed), it is typical to remove the seminal vesicles as part of the procedure. We need to remember that the concept of performing any “radical” procedure includes the surgical removal of the organ and the surrounding or attached structures and tissues (think radical nephrectomy). There would be no medical necessity otherwise to remove the seminal vesicles, and therefore removal cannot be reported separately.
As you note, lymph node dissection CPT 38571 (laparoscopy, surgical; with bilateral total pelvic lymphadenectomy) would be reported if performed, as the pelvic lymph nodes are not directly surrounding the prostate or part of the typical surgical removal of the gland.
CPT 55650 describes “vesiculectomy, any approach” and would be reported with modifier 50 for bilateral removal of both seminal vesicles for those cases in which the vesiculectomy is provided during an encounter that did not include a separate service that included the removal of the seminal vesicles. However, again, this would not be reported separately at the time of radical prostatectomy for the reasons described above, but reported only as a stand-alone procedure for removing the seminal vesicle(s) for a specific reason or pathology or for a medically necessary reason at the time of an unrelated service.
1. Lifecycle of a code: how the CPT and RUC process works. American Medical Association. March 19, 2014. Accessed August 31, 2022. https://bit.ly/3R6Vxdl
Send coding and reimbursement questions to Jonathan Rubenstein, MD, and Mark Painter c/o Urology Times®, at UTeditors@mjhlifesciences.com.
Questions of general interest will be chosen for publication. The information in this column is designed to be authoritative, and every effort has been made to ensure its accuracy at the time it was written. However, readers are encouraged to check with their individual carrier or private payers for updates and to confirm that this information conforms to their specific rules.