Nancy Posted Mon 21st of October, 2019 09:40:34 AM
The patient was taken to the operating room today for robotic exploration and excision of left perirectal mass. The mass was located below the left ureter and lateral to the rectum. The mass was continuous with previously placed titanium clips that were placed during prior open prostatectomy. The mass was quite close to the rectum and bladder. Both were intact at the end of the procedure. The left ureter was identified and was intact. The area of concern extended in the plane between the rectum and bladder in the area of Denonvilliers fascia. Would 38571 be correct or unlisted code?
SuperCoder Answered Tue 22nd of October, 2019 05:45:11 AM
In the procedure code 38571, the provider enters the abdomen, and there is good visualization of the cavity, he removes any adhesions if present. Then the provider explores the abdomen, and excises all of the lymph nodes in the pelvis. Additionally, in cases of extensive metastatic cancer it may be necessary to remove all of the lymph nodes in the area of the disease. For cancer in the lower abdomen the provider may remove the pelvic lymph nodes and other tissues in the pelvis and abdomen. Whereas, in your case, the mass below the left ureter and lateral to the rectum has been explored and excised, so CPT 38571 would not be appropriate code to bill.
However, there is temporary procedure code 0184T in which the provider uses the transanal endoscopic microsurgical approach for identification and removal of a rectal tumor. In this approach, he inserts the proctoscope to identify the tumor. He then insufflates the lumen of the rectum with high flow carbon dioxide. The provider dissects the tumor from its lower edge by keeping a macroscopic margin of 5 mm from the tumor. He continues full–thickness resection circumferentially and safeguards the normal surrounding mucosa. The provider then irrigates the rectum with antimicrobial agents like iodopovidone solution and sutures the rectal wall. Finally, he examines the rectum through the proctoscope for appropriate closure. But, procedure 0184T, partially match with the excision of perirectal mass. Although, you can check the completed op-report, if matches then you can bill this code.
Since, there is no specific defined code for the robotic exploration and excision of left perirectal mass, so it is suggested to bill the unlisted code from the urinary system, i.e. 51999 (Unlisted laparoscopy procedure, bladder). When reporting a procedure with an unlisted code, submit a cover letter explaining the reason for choosing the unlisted code instead of a defined, active code. Also include the operative notes or other relevant documentation to strengthen the claim and to avoid a possible denial. Your payers will consider claims with unlisted procedure codes on a case by case basis, and they will determine payment based on the documentation you provide.
Hope this helps!