Urology Coding Alert

How did you do on the modifier quiz? Find out below.

Answer 1: You should report CPT 55845 (Prostatectomy, retropubic radical, with or without nerve sparing; with bilateral pelvic lymphadenectomy ...) for the prostatectomy and node dissection. You need to append mod-ifier 52 (Reduced services), however, says Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology, State University of New York, Stony Brook.

This modifier indicates to the payer that the urologist performed a unilateral node dissection rather than the bi-lateral node dissection that the code descriptor specifies.

Answer 2: Report 99213 (Office or other outpatient visit for the evaluation and management of an established patient ...) for the office visit. Since the patient's problem prompted the urologist to perform the office visit and a separate procedure, you need to append modifier 25 (Sig-nificant, separately identifiable evaluation and manage-ment service by the same physician on the same day of the procedure or other service) to 99213, Ferragamo says.

Then report 81002 (Urinalysis, by dipstick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific gravity, uro-bilinogen, any number of these constituents; non-automated, without microscopy) for the urinalysis and 52000 (Cystourethroscopy [separate procedure]) for the in-office cystoscopy.

For a Medicare patient, you can use the same diagnosis for the E/M visit and for the procedure -- in this case, gross hematuria (599.89). Some carriers may require separate diagnoses. In this case, you could use 599.89 for the E/M, and use the findings of the cystoscopic examination for the surgical procedure (bladder tumor, 188.2).

Answer 3: You should append modifier 22 (Increased procedural services) in this scenario. Report 51595-22 (Cystectomy, complete, with ureteroileal conduit or sigmoid bladder, including intestine anastomosis; with bilateral pelvic lymphadenectomy, including external iliac, hypogastric, and obturator nodes). Have your urologist include details in a cover letter that explain the extra time and labor spent, and why it warrants modifier 22, Ferragamo says.

Keep in mind that modifier 22 applies only to unusual procedures, not E/M services. Also, check your individual carrier's policy before submitting a claim using modifier 22 because not all private payers recognize this modifier.

Answer 4: Both physicians working as co-surgeons will report the same procedure codes:

• 51595 (Cystectomy, complete, with ureteroileal conduit or sigmoid bladder, including intestine anastomosis; with bilateral pelvic lymphadenectomy, including external iliac, hypogastric, and obturator nodes) for the cystectomy

• 58150 (Total abdominal hysterectomy [corpus and cervix], with or without removal of tube[s], with or without removal of ovary[s]) for the hysterectomy

• 50605 (Ureterotomy for insertion of indwelling stent, all types) for the stent placement. The coding differences for each physician come in the modifier applications.

In this case, each physician should append modifier 62 (Two surgeons) to 51595 to show the payer that they acted as co-surgeons for this procedure, Ferragamo says. The urologist performed the complete cystectomy and the bilateral pelvic node resection, and the general surgeon performed the ileal conduit.

Because the urologist also performed the hysterectomy, add modifier 51 (Multiple procedures) to 58150. Append modifiers 50 (Bilateral procedure) and 80 (Assistant surgeon) to 50605 because the urologist acted as the assistant surgeon for the bilateral ureterotomy for insertion of indwelling stents (performed by the general surgeon).

The general surgeon will also report 58150-80-51 because he assisted with the total hysterectomy, and 50605-50-51 because he was the surgeon for the bilateral ureterotomy for insertion of indwelling stents during his performance of the ileal conduit.

Tip: Payers will not reimburse for assistants at surgery in all cases, regardless of the modifiers you append to the claim.

"Many carriers create their own rules that determine which practitioners can bill as assistant surgeons," says Barbara J. Cobuzzi, MBA, CPC-OTO, CPC-H, CPC-P, CPC-I, CHCC, president of CRN Healthcare Solutions, a coding and reimbursement consulting firm in Tinton Falls, N.J.

Answer 5: For the TURP, you should report 52601 (Transurethral electrosurgical resection of prostate, including control of postoperative bleeding, complete [vasectomy, meatotomy, cystourethroscopy, urethral calibration and/or dilation, and internal urethrotomy are included]).

Then report 99213 for the patient's office visit. Since a TURP has a 90-day global period and an office visit for an unrelated problem occurred during the postoperative global period of the TURP, append 99213 with modifier 24 (Unrelated E/M service by the same physician during a postoperative period).