Example A — Robotic radical prostatectomy with lymphadenectomy
Clinical: Intermediate-risk localized disease; robot-assisted laparoscopic radical prostatectomy with separately documented bilateral pelvic lymph node dissection.
Code(s): 55866; 38571 [VERIFY: NCCI pairing].
Dx: C61.

Example B — Robotic radical prostatectomy, no nodal dissection
Clinical: Favorable-intermediate-risk disease; nerve-sparing robotic radical prostatectomy without lymphadenectomy.
Code(s): 55866 only.
Dx: C61.

Example C — Open radical retropubic prostatectomy with bilateral nodes
Clinical: Open case with bilateral pelvic lymphadenectomy performed through the same incision.
Code(s): 55845 (nodal work included in the code — no separate lymphadenectomy code).
Dx: C61.

Example D — Unrelated E/M during the 90-day global
Clinical: Six weeks after prostatectomy, the patient is seen for a new kidney stone episode.
Code(s): Established-patient E/M with modifier -24.
Dx: the stone diagnosis (not C61) as primary.

• Indication: cancer diagnosis, risk category, and shared decision for surgery
• Approach: robotic/laparoscopic vs open; conversion documented if it occurred
• Extent: radical resection described (prostate + seminal vesicles); nerve-sparing detail
• Lymphadenectomy: separately described dissection with anatomic boundaries when separately billed
• Added complexity: time/effort detail whenever modifier -22 will be reported

• 99024: log routine post-op visits (some MACs collect this data)
• Modifiers: -24 unrelated E/M; -78 unplanned return; -79 unrelated procedure; -58 staged

• Lymphadenectomy bundling: confirm the NCCI status of 38571 with 55866 and document the dissection separately [VERIFY: NCCI].
• S2900 write-offs: do not bill robotic assistance to payers that never recognize it; build the contract list once and follow it.
• Wrong family: radical vs simple prostatectomy code mismatch against the documented indication invites recoupment.
• Global E/M denials: unrelated visits during the 90-day global need modifier -24 and a non-cancer primary diagnosis.

• 55866 – Laparoscopy, surgical prostatectomy, retropubic radical, including nerve sparing; includes robotic assistance when performed
• 55840 – Prostatectomy, retropubic radical, with or without nerve sparing (open)
• 55842 – open radical with lymph node biopsy(s)
• 55845 – open radical with bilateral pelvic lymphadenectomy

• 38571 – Laparoscopy, surgical; with bilateral total pelvic lymphadenectomy [VERIFY: NCCI pairing with 55866]

• 55821 – Prostatectomy, suprapubic, subtotal
• 55831 – Prostatectomy, retropubic, subtotal
• Reminder: these are typically BPH cases — the indication and pathology must match the code family.

• S2900 – Surgical technique requiring use of robotic surgical system — not payable by Medicare; bill only where a payer contract recognizes it [VERIFY: payer policy]

• C61 – Malignant neoplasm of prostate (primary dx for the surgical claim)
• Z19.1 / Z19.2 – Hormone sensitivity status when documented
• Z85.46 – Personal history — later surveillance encounters only, never the surgery claim

Tip: for post-op complications, code the specific complication as primary on those encounters, with C61 or Z85.46 as appropriate to the cancer status.

• Indication: cancer diagnosis, risk category, treatment decision
• Approach and extent: stated explicitly; conversion documented
• Nodal dissection: separately described when separately billed
• Nerve sparing: technique described (included in the code, supports the record)
• Global-period services: related vs unrelated clearly distinguished for modifier support

• -22 increased procedural services — documented added work (salvage surgery, dense adhesions, very large gland)
• -24 / -78 / -79 / -58 for global-period E/M and returns to the OR
• -62 / -80/-82 co-surgeon and assistant rules per payer; assistant coverage for 55866 is payer-specific [VERIFY: assistant-at-surgery indicator]

• 55866, 55840–55845, 55821/55831: 90-day global.
• Confirm using your MAC/payer fee schedule.

• Facility charge capture: 55866 (robotic/lap radical) is the workhorse; most cases run as inpatient or extended-recovery outpatient — confirm site-of-service and status rules for your payers [VERIFY: current IPO/site-of-service status].
• Robot costs: robotic system time and disposables are facility overhead — not separately payable; do not append S-codes to Medicare facility claims.
• Nodal dissection: capture 38571 only when the dissection is separately documented.

• C61 – primary diagnosis on the surgical claim
• Z19.1 / Z19.2 – hormone sensitivity status when documented

Facility tip: align the facility claim's diagnosis and procedure coding with the physician op note; for inpatient cases, ICD-10-PCS coding must reflect the documented approach and extent.

• Op note detail: approach, extent, nodal work, and any conversion in the facility record
• Implant/supply log: robotic instruments and disposables per charge policy (overhead vs chargeable per facility rules)
• Status/stay documentation: the record must support the billed patient status (inpatient vs outpatient) under current payer rules
• Record alignment: op note, anesthesia record, nursing record, and charge capture must tell the same story

• Site-of-service variance: inpatient vs hospital outpatient status for radical prostatectomy is payer-driven and audited — keep status criteria documentation current [VERIFY: payer status rules].
• Packaging rules vary: supplies and imaging package differently across settings.
• Readmissions/returns: track returns to the OR within the global for correct facility claim relationships.