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    What happens when prior auths don’t match services provided?

    Obtain revised prior authorization and submit to payer as soon as possible

     

    My doctor just performed his first partial cystectomy using robotic laparoscopy. This was a complicated case since the patient had previous radiation to the area. I can’t find a code for that. How should I bill it?

    You are correct; there is no robotic partial cystectomy code.

    However, the open code for partial cystectomy, as well as the open code for partial cystectomy, complicated, does not comment on approach. Therefore, it can be used to report the procedure performed with open surgery, laparoscopic surgery, or robotics.

    Read: How to charge for E&M services, procedure on same date

    We recommend that you report the surgery using code 51555 (Cystectomy, partial; complicated [eg, postradiation, previous surgery, difficult location]).

    The AUA has also recommended this path. However, as always, you should check with your payer policies and develop policies for your practice that fit a standard protocol as there are many groups and payers that prefer reporting of the unlisted code instead.

    Next: Reimbursement for a new device to assist in the instillation of drugs into the bladder

    Ray Painter, MD
    Urologist Ray Painter, MD, is president of Physician Reimbursement Systems, Inc., in Denver, and is also publisher of Urology Coding and ...
    Mark Painter
    Mark Painter is CEO of PRS Urology SC in Denver.

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