Summary & Overview
CPT 55815: Perineal Prostatectomy with Lymph Node Dissection
CPT code 55815 designates a perineal prostatectomy with removal of regional lymph nodes for treatment of prostate cancer. This surgical oncology code captures a definitive, invasive procedure used to remove the prostate gland via a perineal approach and to obtain nodal tissue for staging and margin assessment. Nationally, accurate use of this code affects surgical case counts, quality measurement, cancer staging capture, and hospital inpatient billing for urologic oncology services.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The content reviews reimbursement benchmarks, billing and coding considerations, and the clinical context in which 55815 is reported. Readers will find an overview of typical sites of service and service type, discussions of common billing modifiers and practice patterns, and context on how the code interacts with inpatient surgical workflows and pathology submission for nodal analysis.
This summary provides clinicians, coders, and payer contracting analysts with a concise reference to the clinical intent of the code, the procedural elements that support its assignment, and the topics typically relevant when assessing coverage, claims submission, and quality reporting for perineal prostatectomy with lymph node dissection.
Billing Code Overview
CPT code 55815 describes a perineal prostatectomy for treatment of prostate cancer. The procedure involves excision of the prostate gland through an incision in the perineum, with removal of nearby tissues to achieve oncologic control. The provider also removes regional lymph nodes — including the external iliac, hypogastric, and obturator nodes — and sends them for laboratory analysis.
Service type: Surgical oncology / urologic surgery
Typical site of service: Inpatient hospital operating room
Clinical & Coding Specifications
Clinical Context
A 68-year-old man with biopsy-proven, clinically localized prostate adenocarcinoma (e.g., Gleason score 7, rising PSA) is scheduled for a radical perineal prostatectomy with pelvic lymphadenectomy. He presents on the day of surgery after preoperative evaluation confirming fitness for general anesthesia. In the operating room, the urologic surgeon makes a perineal incision to excise the prostate gland, performs wide local excision of adjacent tissue as indicated by tumor extent, and removes regional lymph nodes (external iliac, hypogastric, obturator) for pathologic staging. Resected specimens are labeled and sent to the pathology laboratory for histologic assessment, margin evaluation, and nodal metastasis. Typical perioperative workflow includes preoperative consent and imaging review, intraoperative specimen handling, immediate postoperative recovery and pain control, and coordination of pathology results to guide further oncology management.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
11 | Normal, postoperative recovery | Use for the primary, normally performed service when no unusual circumstances apply. |
22 | Increased procedural services | Use when additional work substantially beyond the typical is required (e.g., extensive adhesiolysis or extensive resection beyond usual scope). |