Urology Coding Alert

Organ or tissue replaced by transplant; kidney) and 996.81 (Complications of transplanted organ; kidney) as secondary diagnoses Ferragamo says.

Procedure coding: The proper CPT codes to report for the procedures depend on what exactly the urologist is doing with the nephrostomy Ferragamo says.
If the urologist drained and relocated the nephrostomy tube on the skin report:
 

  49010 (Exploration retroperitoneal area with or without biopsy[s] [separate procedure]) for the exploration of the retroperitoneal space and drainage   of the hematoma
 

 50398 (Change of nephrostomy or pyelostomy tube) for the change of the nephrostomy tube.

"I would append modifier -78 (Return to the operating room for a related procedure during the postoperative period) to each code " Ferragamo says "because this is a treatment of a complication in the global period of the transplant procedure." Since the global period for the original transplant 50360-50365 (Renal allotransplantation implantation of graft ...) is 90 days appending modifier -78 will allow you to bill for the new procedures within that time period.

Don't miss: When you file claims with modifier -78 don't hold your breath for the full fee schedule reimbursement amount. Procedures that you bill with modifier -78 include only the "intraoperative" portion of the service says Christine Jolitz CPC-A coder for Urology Associates in Wauwatosa Wis. meaning payers will make no payment for pre- and postoperative care. Insurers generally reimburse modifier -78 procedures at 65-80 percent of the full fee schedule value depending on the payer. But when you append modifier -78 you do not incur a "new" global period.

However: If the procedure was a redo of the nephrostomy tube and drainage of the hematoma Ferragamo suggests reporting only one CPT code: 50040 (Nephrostomy nephrotomy with drainage). This code covers the redo of the nephrostomy tube in a different site both in the kidney and skin exit port. Append modifier -78 to 50040.
Diagnosis: List 591 (Hydronephrosis) as the primary ICD-9 code. Report 866.01 996.81 and V42.0 as secondary diagnoses.

According to NCCI code 50040 includes 49010 as well as 49000 (Exploratory laparotomy exploratory celiotomy with or without biopsy[s] [separate procedure]). The modifier indicator on both of these bundles is "0 " so you can't use a modifier to report the exploratory laparotomy separately.

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