Coding tips for CPT code 55866 for Robotic Prostectomy

Robotic-assisted surgery refers to technology that allows the surgeon to operate from a console, remote from the patient and not in sterility. Many hospitals have adopted this technology in the fields of: Urology, Gynecology (Oncology, Urogynecology and General Gynecology), and Colorectal Surgery. In medical coding, we have even separate procedure codes like CPT code 55866 for Robotic Prostectomy for coding robotic surgery.

Surgical procedures completed with robotic assistance should be billed using existing CPT codes for laparoscopic surgical procedures. Surgical laparoscopy always includes diagnostic laparoscopy

Description of CPT code for robotic Prostectomy

55866 – Laparoscopy, surgical prostatectomy, retropubic radical, including nerve sparing, includes robotic assistance, when performed

The physician performs a laparoscopic radical prostatectomy, sometimes using robotic assistance. This cannot be done on a patient with prior open prostate surgery. The patient is positioned for laparoscopic surgery with the legs in low lithotomy position for rectal access. Five trocars are placed and the cavity is insufflated with gas. The vas deferens is divided, the seminal vesicles are mobilized, and the prostate is dissected off the rectum. The space of Retzius is developed by dividing the urachus medial to the umbilical ligaments. The endopelvic fascia is incised on both sides and the prostatic levator muscle attachments are bluntly removed. A suture is passed between the urethra and dorsal venous complex and tied. A second suture is passed through the anterior prostate. The bladder neck is opened anteriorly, the posterior margin is separated from the prostate, and the underlying seminal vesicles are exposed. The two prostatic pedicles are divided close to the prostate with the involved seminal vesicle retracted. The back surface of the prostate on each side is dissected from the neurovascular bundles until the prostate remains attached only at the apex. Between the two previously placed sutures, the dorsal vein is divided, the urethra is exposed, and the catheter is removed. The urethra is completely divided. The surgeon places a finger in the rectum for guidance and divides the muscles and remaining attachments to free the prostate completely. The vesicourethral anastomosis is done next with polyglycolic acid suture in running or interrupted simple sutures. A Foley catheter is placed and the anastomosis of the bladder to the urethra is tested. A suction drain is placed through a trocar site and the prostate is removed through a small port site incision.

For open procedure of protatectomy always use CPT code 55840.

55840 – Prostatectomy, retropubic radical, with or without nerve sparing

The physician performs a radical prostatectomy (removal of the prostate gland) through an incision made in the lower abdomen just above the pubic area. In preparation for removal of the prostate, a catheter is passed into the urethra into the bladder. Through a lower abdominal incision, with or without care to spare the nerves in the area, the urinary bladder is exposed and displaced backwards to enter the space behind the pubic bone and expose the area of the prostate. The gland with the capsule intact and the seminal vesicles and the portions of the vas deferens in the area are removed by freeing the prostate by blunt dissection and by transecting the urethra and cutting through the bladder outlet. The urinary catheter is brought into the operative site and used to create traction for the dissection. A second catheter is placed in the bladder after the first one is removed along with the prostate. The transected urethra is repaired by suturing to the newly created bladder outlet. A rubber drain is placed in the space between the pubic bone and the bladder and brought out through a separate stab wound. The dissected tissues and the skin incision are closed in layers by suturing