How To Use CPT Code 55866

CPT 55866 refers to a laparoscopic, surgical prostatectomy, retropubic radical, including nerve sparing, with the possibility of robotic assistance. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 55866.

1. What is CPT 55866?

CPT 55866 is a medical procedure code used to describe a laparoscopic, surgical prostatectomy, retropubic radical, including nerve sparing, with the possibility of robotic assistance. This procedure is performed to remove the prostate gland and some surrounding tissue while preserving the nerve supply in patients with early-stage prostate cancer.

2. 55866 CPT code description

The official description of CPT code 55866 is: Laparoscopy, surgical prostatectomy, retropubic radical, including nerve sparing, includes robotic assistance, when performed.

3. Procedure

The 55866 procedure involves the following steps:

1. The patient is placed in a supine position, prepped, and appropriately anesthetized.
2. A catheter is inserted through the urethra and into the bladder.
3. An infraumbilical incision is made, and the laparoscope is inserted, followed by several more incisions for the placement of a Veress needle and trocars for additional instruments.
4. The bladder is filled with saline to identify its contours.
5. The provider incises the pouch of Douglas and exposes the Denonvilliers’ fascia.
6. The vasa deferentia are divided with bipolar forceps, and the seminal vesicles are freed.
7. The space of Retzius is entered, and dissection continues down to the urachus, freeing the bladder.
8. The endopelvic fascia is opened, and the levator ani fibers are pushed away to free the lateral prostate, revealing the lateral and inferior aspect of the dorsal venous prostatic complex.
9. Santorini’s plexus is ligated with sutures.
10. The bladder neck is dissected and opened, as well as Denonvilliers fascia, to access the seminal vesicles and vasa deferentia; further maneuvering exposes both sides of the prostatic pedicles.
11. Dissection around the lateral margins of the prostate is performed to preserve the neurovascular bundles, and the prostatic pedicles are transected.
12. The apex of the prostate is dissected by sectioning the dorsal venous complex and transecting the urethra and Denonvilliers fascia.
13. A urethrovesical anastomosis is created with six separate suture ligatures.
14. A Foley catheter is placed in the bladder prior to complete closure, and saline is instilled to check for anastomosis leakage.
15. All instruments and trocars are removed, and the incisions are closed.

4. Qualifying circumstances

Patients eligible to receive CPT code 55866 services are those diagnosed with early-stage prostate cancer who require a surgical prostatectomy. The procedure aims to remove the prostate gland and some surrounding tissue while preserving the nerve supply. This code is applicable when the procedure is performed laparoscopically and may include robotic assistance.

5. When to use CPT code 55866

It is appropriate to bill the 55866 CPT code when a laparoscopic, surgical prostatectomy, retropubic radical, including nerve sparing, is performed on a patient with early-stage prostate cancer. The code also covers the use of robotic assistance during the procedure, if applicable.

6. Documentation requirements

To support a claim for CPT 55866, the following information should be documented:

• Patient’s medical history and diagnosis of early-stage prostate cancer
• Indication for the surgical prostatectomy, retropubic radical, including nerve sparing
• Details of the laparoscopic procedure, including the use of robotic assistance, if applicable
• Operative report describing the step-by-step process of the procedure
• Postoperative care and follow-up instructions

7. Billing guidelines

When billing for CPT code 55866, it is essential to ensure that the patient’s medical records contain the necessary documentation to support the claim. Additionally, be aware of any payer-specific guidelines or requirements related to billing for this code. It is also crucial to verify if any other codes apply to the procedure, such as anesthesia or postoperative care codes.

8. Historical information

CPT 55866 was added to the Current Procedural Terminology system on January 1, 2003. There have been changes to the code since its addition, with the most recent change occurring on January 1, 2011, when the descriptor was updated to include robotic assistance.

9. Similar codes to CPT 55866

Five similar codes to CPT 55866 and how they differ are:

1. CPT 55801: Open radical retropubic prostatectomy, without nerve sparing
2. CPT 55812: Open radical retropubic prostatectomy, with bilateral nerve sparing
3. CPT 55815: Open radical retropubic prostatectomy, with unilateral nerve sparing
4. CPT 55840: Open radical perineal prostatectomy, without nerve sparing
5. CPT 55845: Open radical perineal prostatectomy, with nerve sparing

These codes differ from CPT 55866 in the approach (open vs. laparoscopic) and the inclusion or exclusion of nerve sparing during the procedure.

10. Examples

Here are 10 detailed examples of CPT code 55866 procedures:

1. A 60-year-old male with early-stage prostate cancer undergoes a laparoscopic, surgical prostatectomy, retropubic radical, including nerve sparing, with robotic assistance.
2. A 65-year-old male with early-stage prostate cancer undergoes a laparoscopic, surgical prostatectomy, retropubic radical, including nerve sparing, without robotic assistance.
3. A 55-year-old male with early-stage prostate cancer undergoes a laparoscopic, surgical prostatectomy, retropubic radical, including nerve sparing, with robotic assistance, and experiences postoperative complications requiring additional intervention.
4. A 70-year-old male with early-stage prostate cancer undergoes a laparoscopic, surgical prostatectomy, retropubic radical, including nerve sparing, without robotic assistance, and has a successful recovery with no complications.
5. A 62-year-old male with early-stage prostate cancer undergoes a laparoscopic, surgical prostatectomy, retropubic radical, including nerve sparing, with robotic assistance, and requires additional postoperative care due to urinary incontinence.
6. A 58-year-old male with early-stage prostate cancer undergoes a laparoscopic, surgical prostatectomy, retropubic radical, including nerve sparing, without robotic assistance, and experiences postoperative complications requiring further treatment.
7. A 67-year-old male with early-stage prostate cancer undergoes a laparoscopic, surgical prostatectomy, retropubic radical, including nerve sparing, with robotic assistance, and has a successful recovery with no complications.
8. A 63-year-old male with early-stage prostate cancer undergoes a laparoscopic, surgical prostatectomy, retropubic radical, including nerve sparing, without robotic assistance, and requires additional postoperative care due to urinary incontinence.
9. A 59-year-old male with early-stage prostate cancer undergoes a laparoscopic, surgical prostatectomy, retropubic radical, including nerve sparing, with robotic assistance, and experiences postoperative complications requiring further treatment.
10. A 66-year-old male with early-stage prostate cancer undergoes a laparoscopic, surgical prostatectomy, retropubic radical, including nerve sparing, without robotic assistance, and has a successful recovery with no complications.