Urology Coding Alert
Determine Your Level of Flank Drainage Knowledge
Modifier 57 will come in handy when coding these procedures. When your urologist carries out procedures to drain the flank or other regions, it’s crucial to review the medical records for various specifics, such as the method used and whether an abscess or other pathological conditions like a lymphocele were drained. Test your flank drainage knowledge with this quiz. Question 1: How do you document the initial decision to perform a flank procedure? Suppose during a new patient assessment for symptoms of flank pain and fever, the urologist identifies a renal abscess in the patient by ultrasound (US) and/or computerized tomography (CT) scan. The urologist spends 35 minutes conducting a medically appropriate history and examination. The physician then makes the decision to carry out an open drainage procedure on the renal abscess under anesthesia the following day. Answer: In this case, report 99203 (Office or other outpatient visit for the evaluation and management of a new patient, which requires a medically appropriate history and/or examination and low level of medical decision making. When using total time on the date of the encounter for code selection, 30 minutes must be met or exceeded. ) for the evaluation and management (E/M) visit with modifier 57 (Decision for surgery) appended for the first E/M visit. The next day when the patient has the drainage procedure, report 50020 (Drainage of perirenal or renal abscess, open) for the renal abscess drainage procedure. Modifier 57 explained: Append modifier 57 to an E/M service with a 90-day global period. The global period begins on the same day, or on the day before, a major surgical procedure, and results in the physician’s decision to perform the surgery. “A separate diagnosis code is not necessary for the use of an E/M code with modifier 57,” confirms Chelle Johnson, CPMA, CPC, CPCO, CPPM, CEMC, AAPC Fellow, billing/credentialing/auditing/coding coordinator at County of Stanislaus Health Services Agency in Modesto, California. Guidelines from the Centers for Medicare & Medicaid Services (CMS) identify a major surgical procedure as any procedure with a 90-day global period. When you look up the global period for 50020, it is assigned a 90-day global period. Modifier 57 is used “only when the decision for surgery was made during the pre-op period of a major surgery (services with a 90-day follow-up period),” says Juan Lumpkin, provider relations senior analyst at CGS Administrators, LLC in Nashville, Tennessee. “The preoperative period is the day before and the day of the surgical procedure,” he adds. Note: The Medicare Claims Processing Manual, Chapter 12, Section 30.6.6.C, instructs carriers to “pay for an evaluation and management service on the day of or on the day before a procedure with a 90-day global surgical period if the physician uses CPT® modifier 57 to indicate that the service resulted in the decision to perform the procedure.” Helpful tip: In order to correctly apply modifier 57, keep in mind that the E/M service must be associated with the subsequent procedure, and the same doctor (or tax ID) must be the one providing both the E/M service and the surgical operation. Question 2: Which codes should be reported when the urologist performs peritoneal or retroperitoneal drainage? Answer: This answer will also depend on a few more details. Let’s take a look. Open drainage: Report code 49062 (Drainage of extraperitoneal lymphocele to peritoneal cavity, open) if the urologist performs open drainage of a lymphocele. On the other hand, report code 49060 (Drainage of retroperitoneal abscess, open) if the urologist performs open drainage of a retroperitoneal abscess. Finally, report code 49020 (Drainage of peritoneal abscess or localized peritonitis, exclusive of appendiceal abscess, open) if the urologist performs open drainage of a peritoneal abscess. Laparoscopic drainage: If your urologist performs laparoscopic peritoneal drainage for a lymphocele, report code 49323 (Laparoscopy, surgical; with drainage of lymphocele to peritoneal cavity). Percutaneous drainage: Report 49406 (Image-guided fluid collection drainage by catheter (eg, abscess, hematoma, seroma, lymphocele, cyst); peritoneal or retroperitoneal, percutaneous) if the urologist performs percutaneous drainage via a catheter for a peritoneal or retroperitoneal lymphocele or abscess. Lymphocele defined: A lymphocele is a complication that can occur after surgery, such as renal transplantation or retroperitoneal surgery, when damage to the lymphatic system leads to the leakage of lymph fluid from the lymphatic channels, resulting in accumulation in a nearby space or cavity. Question 3: What codes should be used for renal and perirenal drainage? Answer: The appropriate CPT® codes will vary based on whether the urologist executed an open or percutaneous drainage of the perirenal or renal abscess. Open drainage: If the patient has a complicated (multiloculated or multiple) perirenal or renal abscess or abscesses, the urologist will probably choose an open method of drainage. Report code 50020 (Drainage of perirenal or renal abscess, open) for open drainage. Percutaneous drainage: If the urologist performs percutaneous image-guided drainage of a perirenal or renal abscess via a catheter, report code 49405 (Image-guided fluid collection drainage by catheter (eg, abscess, hematoma, seroma, lymphocele, cyst); visceral (eg, kidney, liver, spleen, lung/mediastinum), percutaneous). Remember: Never report code 49405 in conjunction with the following codes:
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