How To Use CPT Code 55810

CPT 55810 describes the perineal radical prostatectomy procedure, which involves the surgical removal of the prostate gland through an incision in the perineum. This article will cover the description, official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 55810?

CPT 55810 is used to describe the perineal radical prostatectomy procedure. This surgical procedure involves the excision of the prostate gland to treat prostate cancer. The provider makes an incision in the perineum and removes the prostate gland, along with nearby structures such as the vas deferens and seminal vesicles, to ensure the removal of all cancerous tissue and prevent its spread.

2. Official Description

The official description of CPT code 55810 is: ‘Prostatectomy, perineal radical.’

3. Procedure

1. The patient is appropriately prepped and anesthetized.
2. The provider makes an inverted U-shaped incision in the perineum.
3. The rectum is separated from the posterior part of the prostate.
4. The provider excises the prostate gland, vas deferens, and seminal vesicles.
5. Surrounding tissues are excised to achieve a clear margin of healthy tissue.
6. A catheter is inserted into the urinary bladder for drainage.
7. The area is irrigated, checked for bleeding, and the incision is closed.

4. Qualifying circumstances

CPT 55810 is performed on patients with prostate cancer who require the surgical removal of the prostate gland. The procedure is typically performed by a qualified healthcare professional. It is important to note that Medicare considers this procedure as an Inpatient Only (IPO) service.

5. When to use CPT code 55810

CPT code 55810 should be used when a perineal radical prostatectomy is performed to treat prostate cancer. It is important to ensure that the procedure is performed through an incision in the perineum and involves the excision of the prostate gland.

6. Documentation requirements

To support a claim for CPT 55810, the healthcare professional must document the following information:

• Patient’s diagnosis of prostate cancer
• Description of the procedure performed, including the incision site and structures excised
• Date of the procedure
• Any complications or additional procedures performed
• Signature of the healthcare professional performing the procedure

7. Billing guidelines

When billing for CPT 55810, ensure that the procedure meets the criteria for a perineal radical prostatectomy. It is important to follow the guidelines set by Medicare for Inpatient Only (IPO) services. It is also important to use the appropriate modifiers, if required, to indicate any additional procedures or complications.

8. Historical information

CPT 55810 was added to the Current Procedural Terminology system on January 1, 1990. The code underwent a code change on January 1, 2010, with no further updates since then. Medicare added this procedure to the Inpatient Only (IPO) list in 2017.

9. Examples

1. A patient with prostate cancer undergoes a perineal radical prostatectomy to remove the prostate gland and prevent the spread of cancer.
2. A healthcare professional performs a perineal radical prostatectomy on a patient with localized prostate cancer.
3. A provider excises the prostate gland through an incision in the perineum to treat a patient with aggressive prostate cancer.
4. A patient with prostate cancer undergoes a perineal radical prostatectomy as part of their treatment plan.
5. A qualified healthcare professional performs a perineal radical prostatectomy on a patient with early-stage prostate cancer.
6. A provider removes the prostate gland through an incision in the perineum to treat a patient with localized prostate cancer.
7. A patient with prostate cancer undergoes a perineal radical prostatectomy to remove the cancerous tissue.
8. A healthcare professional performs a perineal radical prostatectomy on a patient with high-risk prostate cancer.
9. A provider excises the prostate gland through an incision in the perineum to treat a patient with advanced prostate cancer.
10. A patient with prostate cancer undergoes a perineal radical prostatectomy to improve their prognosis and quality of life.