Urology Coding Alert

Let these examples guide your usage.

Appending modifier 52 (Reduced services) can be appropriate for more claims than you might realize. Use the three scenarios below to see how you can apply the same principles to your surgeon’s procedures and file more accurate claims.

Modifier 52 Doesn’t Change the Descriptor

Scenario 1: I need some help coding a laparoscopic simple prostatectomy. Would CPT^® code 55866 with modifier 52 be correct?

Answer: Start by remembering the purpose behind the modifier. A claim with modifier 52 shows the payer that your physician did less than the full procedure represented by a code’s descriptor. Appending the modifier 52, however, should not change the original code descriptor.

Correct coding: Since there is no specific CPT^® code for a simple robotic prostatectomy, you should use the unlisted code 55899 (Unlisted procedure, male genital system). Because 55866 (Laparoscopy, surgical prostatectomy, retropubic radical, including nerve sparing, includes robotic assistance, when performed) is for a radical robotic prostatectomy, this code would not be the proper code for the procedure you describe even if you add modifier 52.

Caveat: Also remember unlisted codes do not accept modifiers. That means modifier 52 should not be applied to the unlisted code 55899. You can, however, use the above reminder about not using 52 to alter descriptors with other claims.

Modifier 52 Can Help Finish Another Surgeon’s Work

Scenario 2: One of our urologists was called into the OR to do a ureteral repair after the general surgeon transected the ureter during his surgery. Our urologist repaired the ureter through the same operative incision made by the general surgeon and also placed a JJ stent.

Answer: Report 50760 (Ureteroureterostomy) for the open ureteral repair. Attach modifier 52 to code 50760 because the open operative field had already been set up by the general surgeon for his particular surgery. Your urologist did not perform a separate incision to secure the operative field he needed to repair the ureter, and he did not perform the closure of the wound which would be performed by the general surgeon. That’s why modifier 52 is appropriate.

You will use diagnosis codes S37.13XA (Laceration of ureter; initial encounter) and N99.72 (Accidental puncture and laceration of a genitourinary system organ or structure during other procedure). 

Watch out: Placement of a ureteral stent at the time of ureteral repair is included in code 50760. Therefore, you should not separately bill for the stent placement.

Another example: A patient had a robotic-assisted laparoscopic hysterectomy (performed by another physician) prior to our robotic-assisted sacrocolpopexy. My physician entered the case with the robot already docked to the patient. How should we report the laparoscopic sacrocolpopexy?

Answer: You will report 57425 (Laparoscopy, surgical, colpopexy [suspension of vaginal apex]) for the laparoscopic sacrocolpopexy. Since your surgeon joined the procedure after the robot was already docked, attach modifier 52 to 57425 to indicate that your urologist did less than the full laparoscopic procedure as described in the code descriptor.

Modifier 52 Can Denote a Partial Procedure

Scenario 3: A urologist performs a unilateral laparoscopic robotic assisted pelvic node resection. How should this unilateral laparoscopic procedure be billed?

Answer: Report code 38571 (Laparoscopy, surgical; with bilateral total pelvic lymphadenectomy). Since the urologist chose to perform only a unilateral lymphadenectomy, append modifier 52 to 38571 to indicate the lesser procedure performed at the personal discretion of the operating urologist.