Urology Coding Alert

In the February 2000 issue of Urology Coding Alert, in an article titled Maximize Pay Up for Same Day Consultation and Cystoscopy, we quoted a source as saying that modifier
-78 (return to the operating room for a related procedure during the postoperative period) should be used when several procedures are performed on the same day, such as a urinalysis, a transrectal ultrasound, an ultrasound with fine-needle guidance, and a prostate fine-needle biopsy. However, modifier -78 would not be appropriate here. Modifier -78 is used to report return trips to the operating room for a related procedure, (e.g., for a complication) during the global period of another procedure. It may not be used to report related procedures performed in the physicians office. There is no CPT or HCPCS modifier to describe related services performed in the physicians office.

Note: As the radiology and pathology codes are not designated as surgical procedures, modifier -78 is not appropriate or relevant for reporting these codes.

The correct modifier in this case is actually modifier
-51 (multiple procedures). If the prostate biopsy was performed on the same date of the cystoscopy, bill modifier -51, for multiple procedures performed at the same session, says Ray Painter, MD, a urologist who is president of PRS, a Denver-based consulting company specializing in coding and reimbursement issues. Medicare would do this anyway, once they saw the claim, he says. You would be paid 100 percent for the most expensive procedure, and 50 percent for the others.

If the prostate biopsy was performed on a different date from the date of the cystoscopy and is within the global period of the cystoscopy, then modifier -58 (staged or related procedure or service by the same physician during the postoperative period) would be appropriate, explains Sandy Page, CPC, CCS-P, co-owner of Medical Practice Support Services of Denver. Modifier -58 is for a staged or related procedure by the same physician during the postoperative period. Modifier -58 may be used to report procedures planned prospectively at the time of the original procedure (staged), a procedure more extensive than the original procedure, or for therapy following a diagnostic procedure (e.g., cystoscopy followed by biopsy), says Page. But the procedures outlined aboveall done on the same date of servicewould call for the modifier -51.

In the same article we reported using code 88171 for a fine-needle biopsy. When the urologist aspirates cells only, using a fine biopsy needle under fluoroscopic guidance, you should code 88171 and 76003, as reported. However, when the urologist, using a core biopsy needle, removes a small amount of tissue from the prostate for analysis under ultrasonic guidance, you should code 55700 (biopsy, prostate; needle or punch, single or multiple, any approach) and 76942 (ultrasonic guidance for needle biopsy, radiological supervision and interpretation).

Tip: If you do a diagnostic ultrasound prior to the biopsy on the same day, code 76872 (echography, transrectal).