How To Use CPT Code 55815

CPT 55815 describes the surgical procedure known as perineal radical prostatectomy with bilateral pelvic lymphadenectomy. This article will cover the official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 55815?

CPT 55815 is a code used to describe a surgical procedure called perineal radical prostatectomy with bilateral pelvic lymphadenectomy. This procedure involves the removal of the prostate gland through an incision made in the perineum. The surgeon also removes nearby lymph nodes, including the external iliac, hypogastric, and obturator nodes, to ensure the removal of all cancerous tissue and prevent its spread.

2. Official Description

The official description of CPT code 55815 is: ‘Prostatectomy, perineal radical; with bilateral pelvic lymphadenectomy, including external iliac, hypogastric and obturator nodes.’

3. Procedure

1. The surgeon makes an inverted U-shaped incision in the perineum.
2. The rectum is separated from the posterior part of the prostate.
3. The surgeon excises the prostate gland, along with the vas deferens and seminal vesicles.
4. Surrounding tissues, including the external iliac, hypogastric, and obturator lymph nodes, are also removed.
5. The excised tissues are sent to a laboratory for analysis.
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 55815 is performed on patients with prostate cancer who require the surgical removal of the prostate gland. The procedure is typically performed by a qualified surgeon who has the necessary expertise in perineal radical prostatectomy. The patient’s condition and medical history must be evaluated to determine the appropriateness of this procedure. The removal of nearby lymph nodes is necessary to ensure the complete removal of cancerous tissue and prevent its spread.

5. When to use CPT code 55815

CPT code 55815 should be used when a perineal radical prostatectomy with bilateral pelvic lymphadenectomy is performed. This code is appropriate for cases where the surgeon removes the prostate gland through an incision in the perineum and also removes nearby lymph nodes, including the external iliac, hypogastric, and obturator nodes.

6. Documentation requirements

To support a claim for CPT 55815, the surgeon must document the following information:

• Patient’s diagnosis of prostate cancer
• Description of the procedure performed, including the incision made and the tissues removed
• Date of the surgery
• Details of the lymph nodes removed
• Results of any laboratory analysis performed on the excised tissues
• Any complications or additional procedures performed
• Signature of the surgeon

7. Billing guidelines

When billing for CPT 55815, ensure that the procedure meets the criteria described in the official description. It is important to accurately document the details of the surgery and any additional procedures performed. CPT code 55815 should not be reported with other codes unless specific circumstances apply. It is recommended to review the billing guidelines provided by the payer to ensure proper reimbursement.

8. Historical information

CPT code 55815 was added to the Current Procedural Terminology system on January 1, 1990. The code has not undergone any updates since its addition. In 2017, it was added to the Inpatient Only (IPO) list for Medicare.

9. Examples

1. A surgeon performs a perineal radical prostatectomy with bilateral pelvic lymphadenectomy on a patient with localized prostate cancer.
2. A patient with prostate cancer undergoes a perineal radical prostatectomy with bilateral pelvic lymphadenectomy to remove the cancerous tissue and nearby lymph nodes.
3. A surgeon performs a perineal radical prostatectomy with bilateral pelvic lymphadenectomy on a patient with an aggressive form of prostate cancer.
4. A patient with prostate cancer undergoes a perineal radical prostatectomy with bilateral pelvic lymphadenectomy as part of their treatment plan.
5. A surgeon performs a perineal radical prostatectomy with bilateral pelvic lymphadenectomy on a patient with recurrent prostate cancer.
6. A patient with prostate cancer undergoes a perineal radical prostatectomy with bilateral pelvic lymphadenectomy to prevent the spread of cancerous cells.
7. A surgeon performs a perineal radical prostatectomy with bilateral pelvic lymphadenectomy on a patient with early-stage prostate cancer.
8. A patient with prostate cancer undergoes a perineal radical prostatectomy with bilateral pelvic lymphadenectomy to achieve complete removal of the cancerous tissue.
9. A surgeon performs a perineal radical prostatectomy with bilateral pelvic lymphadenectomy on a patient with locally advanced prostate cancer.
10. A patient with prostate cancer undergoes a perineal radical prostatectomy with bilateral pelvic lymphadenectomy to improve their chances of long-term survival.