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Robot Assisted Simple Prostatectomy

Nicole Posted Mon 11th of July, 2016 08:58:38 AM
The doctor performed a DaVinci robot-assisted robotic SIMPLE prostatectomy. Would this still qualify for the CPT 55866, even if this was not a "radical prostatectomy" and only a simple? I do not see another code for robot-assisted and I am hoping to not have to use an Unlisted Procedure code. Please Advise.
SuperCoder Answered Tue 12th of July, 2016 03:28:55 AM
Hi Nicole, Since the provider is performing DaVinci robot-assisted robotic SIMPLE prostatectomy CPT, 55866 is the only code that can be billed for this procedure. However, 55866 should be billed with a reduced services modifier "52". Reason being simple prostectomy means when only part of the prostate is removed (typically in benign conditions). Whereas, radical prostectomy involves removal of entire prostate gland along with seminal vesicles, lymphnodes, nerve sparing (typically in malignant cancer). Hence, this procedure should be billed with modifier 52.

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