CPT 55831: Open Prostatectomy via Lower Abdominal Approach - OpenPayer

Summary & Overview

CPT 55831: Open Prostatectomy via Lower Abdominal Approach

CPT code 55831 represents an open prostatectomy performed via a lower abdominal (suprapubic) approach with excision of the prostate gland and vas deferens, urethral incision and enlargement, and hemostatic measures. This major urologic procedure addresses obstructing benign prostatic enlargement or prostate tumors and can be staged over separate operations when necessary. Nationally, accurate coding for this procedure affects hospital billing, quality measurement, and aggregated surgical utilization statistics.

Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical context and typical sites of service, plus what to expect from payer coverage frameworks: common modifier use, inpatient versus outpatient considerations, and implications for surgical service lines. The publication provides benchmarks and policy context related to utilization and coding clarity, highlights clinical indications and procedure staging, and outlines areas where coding precision is important for reimbursement and quality reporting. Data not available in the input is noted where specific benchmarking, taxonomies, ICD-10 mappings, and payer-specific rules would ordinarily be presented.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicare55831CPTprostatectomyurologyopen surgeryoperative-proceduresurgical-codinginpatient-surgery

Billing Code Overview

CPT code 55831 describes an open surgical prostatectomy in which the provider excises the prostate gland and the vas deferens through an incision in the skin crease below the pubic bone (lower abdominal approach). The procedure includes incision and enlargement of the urethra and intraoperative measures to control bleeding. It may be performed to treat a prostate tumor or persistent benign prostatic enlargement that obstructs urinary flow and can be completed in staged procedures when clinically indicated.

Service type: Open surgical prostatectomy (radical or simple prostate excision), major urologic surgery
Typical site of service: Inpatient or outpatient hospital surgical setting, operating room

Clinical & Coding Specifications

Clinical Context

A 68-year-old male presents with progressive urinary obstruction, nocturia, weak stream, and incomplete bladder emptying. Imaging and prostate biopsy confirm a clinically significant prostate neoplasm with obstructive symptoms and/or prosthetic enlargement refractory to medical therapy. After preoperative evaluation, including PSA testing, urinalysis and cross-sectional imaging as indicated, the urologic surgeon performs a retropubic radical prostatectomy through a lower abdominal skin crease incision. The operative steps include dissection and excision of the prostate gland and vas deferens, incision and enlargement of the urethra as needed to restore urinary outflow, hemostasis using sutures and electrocautery, and placement of a urinary catheter for postoperative drainage. Typical workflow includes preoperative anesthesia evaluation, operating room procedure under general or regional anesthesia, immediate postoperative recovery in PACU, inpatient observation for 1–2 days for pain control and monitoring of urine output and drains, and outpatient follow-up for catheter removal and pathology review.

Coding Specifications

Modifier	Description	When to Use
`00`	Reserved for future use / not commonly applied clinically	Data not used clinically for billing; included in raw list but not typically applied
`11`

CPT 55815: Perineal Prostatectomy with Lymph Node Dissection

cpt-55812-radical-perineal-prostatectomy

CPT 55812: Radical Perineal Prostatectomy for Prostate Cancer

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CPT 55821: Open Prostatectomy via Lower Abdominal (Suprapubic) Approach

cpt-55810-perineal-prostatectomy-for-prostate-cancer

CPT 55810: Perineal Prostatectomy for Prostate Cancer

cpt-55842-radical-prostatectomy-with-pelvic-lymph-node-removal

CPT 55842: Radical Prostatectomy with Pelvic Lymph Node Removal

cpt-55840-radical-retropubic-prostatectomy

CPT 55840: Radical Retropubic Prostatectomy

cpt-55845-radical-prostatectomy-with-pelvic-lymph-node-dissection

CPT 55845: Radical Prostatectomy with Pelvic Lymph Node Dissection

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CPT 55865: Perineal Prostate Incision with Lymph Node Sampling

cpt-55862-prostate-perineal-access-brachytherapy-lymph-node-sampling

CPT 55862: Perineal Prostate Access for Brachytherapy with Lymph Node Sampling

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CPT 55860: Perineal Access for Prostate Brachytherapy

Showing 1–10 of 11

Taxonomy Code	Specialty	Notes
208100000X	Urology	Primary specialty performing radical prostatectomy and related prostate surgeries
208000000X	General Surgery	May be involved in complex pelvic surgery or multidisciplinary cases involving adjacent organs
207R00000X	Family Medicine	Rarely performs; more commonly provides pre/postoperative primary care management
208500000X	Obstetrics & Gynecology	Not typical for prostate surgery but included only if pelvic surgery requires gynecologic consultation
207P00000X	Internal Medicine	Provides perioperative medical optimization and comorbidity management

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`C61`	Malignant neoplasm of prostate	Primary oncologic indication for radical prostatectomy to excise tumor and attempt curative treatment
`N40.1`	Benign prostatic hyperplasia with lower urinary tract symptoms	Non-malignant enlargement causing obstructive urinary symptoms that may prompt surgical removal if refractory to medical therapy
`R33.9`	Retention of urine, unspecified	Acute or chronic urinary retention may be an indication for definitive prostate surgery when caused by obstructing prostate disease
`R39.15`	Urgency of urination	Symptom frequently associated with prostatic obstruction influencing the decision for surgical intervention
`N36.1`	Urethral stricture	May coexist or result from prostate disease; surgical planning may include urethral enlargement/incision as part of the procedure

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`55840`	Radical retropubic prostatectomy with bilateral pelvic lymphadenectomy	Performed when lymph node dissection is indicated for staging or suspected spread; may be done during same operative session or as an extended procedure
`55700`	Biopsy, prostate; needle core, any approach, single or multiple cores	Often performed preoperatively to establish diagnosis prompting radical prostatectomy
`52000`	Cystourethroscopy, diagnostic; with or without collection of specimen(s) by brushing or washing	May be used preoperatively to evaluate urethral anatomy or bladder involvement; also used postoperatively if complications arise
`52005`	Cystourethroscopy, with ureteral catheterization, with or without irrigation and/or pyelography	Performed if intraoperative or postoperative assessment of upper tracts is required
`54150`	Circumcision, surgical; neonatal	Example of concurrent urologic minor procedure codes that could be reported if performed during same anesthetic in pediatric/adult contexts (rarely applicable)

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