Working with a co-surgeon: How should procedures be billed? - Urology Times

Ray Painter, MD

Mark Painter

I plan to work with a friend of mine in an unaffiliated urology group to perform a cystoprostatectomy, ileal loop, and lymph node dissection. How should I code for the following two scenarios? First, if I perform the prostatectomy and charge for the prostatectomy and then assist on the rest of the surgery; and second, if I perform the lymph node dissection and then assist on the rest of the surgery.

The codes available to report the primary procedure of cystectomy, 51590 (Cystectomy, complete, with ureteroileal conduit or sigmoid bladder, including intestine anastomosis) and 51595 (Cystectomy, complete, with ureteroileal conduit or sigmoid bladder, including intestine anastomosis; with bilateral pelvic lymphadenectomy, including external iliac, hypogastric, and obturator nodes), include by description cystectomy and loop. As one can see from the description, the primary procedure can be reported with or without nodes.

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When we check the National Correct Coding Initiative bundling edits, prostatectomy codes 55840 (Prostatectomy, retropubic radical, with or without nerve sparing) and 55845 (Prostatectomy, retropubic radical, with or without nerve sparing; with bilateral pelvic lymphadenectomy, including external iliac, hypogastric, and obturator nodes) are not included in either 51590 or 51595 and can therefore be reported separately. However, lymphadenectomy can only be reported once, so code combination is important. Based on the scenarios you have provided, we see two potential coding options.

For scenario 1, in which you perform the prostatectomy and assist on the remainder of the surgery, Surgeon 1 would bill 51595 and 55840–80 or –82. You would bill 55840 and 51595–80 or –82 as appropriate. Modifier –80 specifies an “Assistant Surgeon.” According to CPT, surgical assistant services may be identified by adding modifier –80 to the usual procedure number(s). Modifier –82 specifies an “Assistant Surgeon” (when qualified resident surgeon not available). The unavailability of a qualified resident surgeon is a prerequisite for use of modifier –82 appended to the usual procedure code number(s) as appropriate.

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