Radical Prostatectomy (Robotic-Assisted)

CPT 55866 · 21.9 wRVU · 90-day global
CPT55866
wRVU21.9
Global90-day
ApproachMinimally Invasive
ComplexityComplex
Add-on / Variant CPTs
  • 55868 wRVU: 22.46 — Laparoscopic/robotic prostatectomy with limited pelvic lymph node biopsy(s) — 2026 NEW CODE (22.46 wRVU, 90-day global); replaces 55866 + 38571 for limited nodal sampling
  • 55869 wRVU: 27.41 — Laparoscopic/robotic prostatectomy with bilateral pelvic lymphadenectomy (ext iliac, hypogastric, obturator) — 2026 NEW CODE (27.41 wRVU, 90-day global); replaces 55866 + 38571 for formal bilateral PLND
  • 55845 wRVU: 24.55 — Open retropubic radical prostatectomy with bilateral extended pelvic LND (24.55 wRVU, 90-day global)
  • 55842 wRVU: 20.83 — Open retropubic radical prostatectomy with limited pelvic LND (20.83 wRVU, 90-day global)
  • 55840 wRVU: 20.83 — Open retropubic radical prostatectomy without lymph node dissection (20.83 wRVU, 90-day global)
Preoperative Diagnosis:

Prostate adenocarcinoma, [Gleason X+X=X / Grade Group X], clinical stage [cT2a-T3b], PSA [X] ng/mL

Postoperative Diagnosis:

Same

Procedure Performed:

Robotic-assisted laparoscopic radical prostatectomy (RALP), [nerve-sparing bilateral / nerve-sparing unilateral right / left / non-nerve-sparing] [with bilateral pelvic lymph node dissection]

Attending Surgeon:

[Attending name], MD/DO

First Assistant:

[Resident/PA name]

Anesthesia:

General endotracheal

Indications:

The patient is a [age]-year-old male with biopsy-proven prostate adenocarcinoma, Gleason [X+X=X], Grade Group [X], PSA [X] ng/mL, clinical stage [cT2/cT3]. Multiparametric MRI demonstrated [PI-RADS [X] lesion at (location) / seminal vesicle invasion / extracapsular extension at (location) / no high-risk features]. Risks including bleeding, infection, urinary incontinence, erectile dysfunction, anastomotic stricture, lymphocele (if PLND), and rectal injury discussed. Informed consent obtained.

Findings:

The prostate was [mobile / with limited extracapsular extension suspected at the right / left posterolateral base]. The seminal vesicles were [normal in size / with invasion at the tip]. [Nerve-sparing was feasible bilaterally / unilaterally on the [right / left] / was not feasible given extent of extracapsular extension.] [Bilateral / extended bilateral] pelvic lymph node dissection yielded [X] nodes on the right and [X] nodes on the left ([X] total). The vesicourethral anastomosis was watertight on confirmation.

Description of Procedure:

The patient was positioned supine in steep Trendelenburg (25°). The robotic system was docked. A [12-mm] camera port was placed at the umbilicus. [5] additional robotic and assistant ports were placed in standard configuration.

The peritoneum was incised and the space of Retzius was developed. The bladder was mobilized anteriorly. [Bilateral pelvic lymph node dissection was performed, removing nodal tissue from the external iliac, obturator, and internal iliac (hypogastric) regions bilaterally, and extended to the common iliac nodes at the ureteric crossing.]

The endopelvic fascia was incised bilaterally. The dorsal venous complex (DVC) was [suture-ligated with 0-Vicryl / stapled]. The bladder neck was incised anteriorly and the plane between bladder neck and prostate was developed. The posterior bladder neck was divided and the vasa deferentia were clipped and divided. The seminal vesicles were dissected free.

[Nerve-sparing: The neurovascular bundles were preserved [bilaterally / on the right / on the left] using an [intrafascial / interfascial] technique with cold scissors only — no thermal energy applied to the NVBs. Fascia was preserved over the neurovascular bundles throughout.]

[Posterior reconstruction (Rocco stitch): the rhabdosphincter and Denonvilliers' fascia were reconstructed posteriorly with [2-0 Vicryl] prior to anastomosis to support the external sphincter and promote early continence.]

The urethra was divided sharply at the prostatic apex. The prostate and seminal vesicles were placed in an Endocatch bag. The vesicourethral anastomosis was constructed with running [3-0 V-Loc] suture, [6 stitches posterior then anterior]. Anastomosis was confirmed watertight by filling with [200 mL] saline — no extravasation. A [16 Fr] urethral catheter was placed.

The Endocatch bag was extracted through the camera port incision. Fascia closed with [0-Vicryl]. Skin closed with [4-0 Monocryl].

Complications:

None

Specimens:

Radical prostatectomy specimen (prostate and seminal vesicles): sent to pathology with orientation ink. Pelvic lymph nodes, right and left separately labeled.

Estimated Blood Loss:

[X] mL

Drains:

[19 Fr Blake drain in pelvis — for extended PLND or concern for anastomotic leak] / None

Disposition:

The patient was taken to the PACU in stable condition. Urethral catheter left in place. Ambulatory on post-operative day 1. Drain removed when output less than 50 mL/day with non-urinary creatinine level. Catheter removed at [5-10 days] on post-operative visit.

Epic SmartPhrase Version 
PREOPERATIVE DIAGNOSIS: Prostate adenocarcinoma, Gleason ***, Grade Group ***, PSA ***
POSTOPERATIVE DIAGNOSIS: Same
PROCEDURE PERFORMED: RALP, *** nerve-sparing [+ bilateral PLND]
ATTENDING: ***, MD/DO
ASSISTANT: ***
ANESTHESIA: General

INDICATIONS: .PTAGE-year-old male with prostate cancer Gleason ***, PSA ***, stage cT***. mpMRI: PI-RADS ***, ***. Consent obtained.

FINDINGS: Prostate ***. SV ***. NVB ***. [PLND: *** nodes right, *** nodes left.]

PROCEDURE:
Supine, steep Trendelenburg 25°. Robot docked. Camera umbilicus, *** ports. Space of Retzius developed. [PLND: ext iliac, obturator, int iliac, [common iliac] bilateral; *** nodes right, *** nodes left.] Endopelvic fascia incised. DVC ***. Bladder neck incised anterior/posterior. Vas deferens clipped/divided. SV dissected free. [Nerve-sparing: NVBs preserved ***, intrafascial/interfascial, cold scissors, no thermal energy to NVBs.] [Rocco posterior reconstruction: rhabdosphincter/Denonvilliers reconstructed 2-0 Vicryl.] Urethra divided at apex. Specimen in Endocatch bag. VUA running 3-0 V-Loc, *** stitches, watertight at 200 mL. Foley 16 Fr. Specimen extracted. Fascia 0-Vicryl. Skin 4-0 Monocryl.

EBL: *** mL
SPECIMENS: Prostatectomy specimen + bilateral LNs (separately labeled) to pathology
COMPLICATIONS: None
DISPOSITION: PACU. Ambulatory POD 1. Catheter out day ***.

Signed: .ME, .MYDEGREE
.TODAY
Variants

Open retropubic radical prostatectomy (CPT 55840/55842/55845)

Lower midline or Pfannenstiel incision. Space of Retzius developed. PLND if indicated. DVC suture-ligated. Bladder neck divided. Nerve-sparing with sharp dissection and tactile feedback. Vesicourethral anastomosis with 6 interrupted [2-0 Vicryl] sutures. Open approach provides tactile feedback and is appropriate for anatomically challenging cases, prior pelvic surgery, or settings without robotic access. CPT 55840 (no PLND), 55842 (limited PLND), 55845 (bilateral extended PLND).

Retzius-sparing (posterior/Galfano) approach

Posterior approach without developing the space of Retzius, preserving the anterior puboprostatic ligaments and external sphincter support structures. Peritoneal incision over the Douglas pouch. Seminal vesicles and vas deferens dissected antegrade first. Posterior plane developed from SV tips to prostatic apex. Intrafascial NVB preservation. Anastomosis constructed without DVC ligation. Associated with significantly earlier post-operative continence recovery in multiple RCTs compared to standard anterior approach. No separate CPT — bill 55866/55868/55869 based on PLND performed. Document approach as 'Retzius-sparing (posterior/Galfano technique)' in the operative note.

Salvage radical prostatectomy (after failed radiation/focal therapy)

For locally recurrent prostate cancer after radiation therapy, HIFU, or cryotherapy. Same CPT codes (55866/55868/55869 for robotic, 55840-55845 for open) — the code does not change for salvage intent. However, substantially increased operative complexity due to adhesions, obliterated planes, rectal adherence, and radiation-induced tissue changes justifies modifier -22 (increased procedural service) with documentation of: total operative time vs. typical, specific anatomic challenges encountered, and extra work performed. Higher rates of anastomotic stricture, incontinence, and rectal injury — document risk discussion. Rectal integrity should be confirmed at the end of the case.

Charting Tips
  • Document nerve-sparing status with fascial plane. The three-tier classification: intrafascial (within the prostatic fascia, best NVB preservation, risk of positive margin), interfascial (between prostatic fascia and levator fascia), extrafascial (wide excision, non-nerve-sparing). Document: 'NVBs preserved [bilaterally / unilaterally right / left] using [intrafascial / interfascial] technique with cold scissors; no thermal energy applied to the neurovascular bundles.'
  • Document PLND template and bilateral node counts. Extended template includes external iliac, internal iliac (hypogastric), obturator, and common iliac to the ureteric crossing. Document each side separately: 'pelvic lymph node dissection yielded X nodes on the right and Y nodes on the left.' This is a Commission on Cancer quality metric.
  • Document anastomosis watertightness testing. Fill the bladder with 200 mL saline before closing and confirm no leak. Document: 'vesicourethral anastomosis tested with 200 mL saline — watertight, no extravasation.'
  • Document clinical stage, Grade Group (not just Gleason), pre-op PSA, and mpMRI findings. These drive CPT selection (PLND vs. no PLND, 55866 vs. 55868 vs. 55869) and are required for oncologic documentation and quality reporting.
Billing Tips
  • 55866 (laparoscopic/robotic-assisted radical prostatectomy, including nerve sparing when performed, 21.90 wRVU, 90-day global) covers minimally invasive radical prostatectomy WITHOUT pelvic lymph node dissection. No separate robotic modifier is used; the surgeon bills the same CPT code for laparoscopic or robotic approach.
  • 2026 CPT revision — pelvic lymph node dissection (PLND) is now bundled into separate codes for laparoscopic/robotic prostatectomy. 38571 (laparoscopic bilateral PLND) is no longer separately billable with 55866. Use: 55868 (laparoscopic/robotic prostatectomy with limited pelvic lymph node biopsy(s), 22.46 wRVU) when limited/sentinel nodal sampling is performed; or 55869 (with bilateral pelvic lymphadenectomy including external iliac, hypogastric, and obturator nodes, 27.41 wRVU) when formal bilateral PLND is performed. Billing 38571 with 55866 in 2026 is an unbundling error.
  • Open retropubic radical prostatectomy: 55840 (without lymph node dissection, 20.83 wRVU), 55842 (with limited pelvic LND, 20.83 wRVU), 55845 (with bilateral extended LND, 24.55 wRVU). The perineal approach: 55810 (without LND), 55812 (with LND), 55815 (with extended LND) — these are rare but exist for settings without robotic access.
  • Seminal vesicle excision (55650) is included in the radical prostatectomy — do not separately bill 55650 when SV dissection is performed as part of 55840-55845, 55866, 55868, or 55869.
  • Extended PLND template: the code descriptor for 55869/55845 specifies 'external iliac, hypogastric, and obturator nodes.' Clinical extended PLND also includes common iliac nodes to the ureteric crossing — document the full extent of dissection including common iliac if performed, even though the code descriptor does not require it. Node count from each side should be documented separately (Commission on Cancer quality measure).
  • Global period is 90 days. Anastomotic stricture dilation or cystoscopy performed within 90 days for a related complication uses modifier -78 (unplanned return to OR for complication of the primary procedure) — not modifier -79. Modifier -79 is for unrelated procedures during the global period.
  • Document: clinical stage (cT), Grade Group and Gleason sum, pre-op PSA, nerve-sparing status and fascial plane (intrafascial, interfascial, extrafascial), bladder neck reconstruction, anastomosis method, and lymph node dissection template with node count per side. These support oncologic quality metrics and coding accuracy.

General coding reference. Verify with your institution’s billing department before submitting claims.

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