Urology Coding Alert

A radical cystoprostatectomy with ileocolic urinary diversion, a common urology Procedure requiring more than one physician in the operating room, demands careful coding choices. These choices determine how much each physician will be paid. In the case study below, two urologists, often partners from one practice, perform the bulk of the procedure, with the help of a general surgeon for the intestinal part of the surgery. The coding problem is: How do the two urologists and the general surgeon receive fair compensation for their respective surgical work?   Coding Case Study: Cystoprostatectomy With Three Surgeons   The patient, a 73-year-old male with recurrent carcinoma in situ of the bladder (233.7), is brought to the operating room for a radical retropubic cystoprostatectomy and ileocolic urinary diversion. Two urologists (Dr. A and Dr. B) and a general surgeon (Dr. C) remove the lymph nodes, the bladder, the prostate, seminal vesicles and the vas deferens (the radical cystoprostatectomy) and create a conduit with a loop of bowel (the ileocolic urinary diversion). 
  Drs. A and B perform the radical retropubic cystoprostatectomy. Dr. C performs the ileocolic urinary diversion. The only code that accurately describes the combined procedure is 51595 (cystectomy, complete, with ureteroileal conduit or sigmoid bladder, including bowel anastomosis; with bilateral pelvic lymphadenectomy, including external iliac, hypogastric, and obturator nodes).

The ileocolic urinary diversion is included in 51595, so Dr. C can use that code as well. But this case involves three surgeons. They can't all be reimbursed for 51595.   Using Modifier -62   If the case involved only two physicians, one performing the radical cystoprostatectomy and one doing the bowel loop, the best choice would be for each to bill 51595 with modifier -62 (two surgeons). Both physicians -- whether two urologists, or one urologist and one general surgeon -- would be acting as primary surgeons. The total fee for 51595 jumps to 125 percent of the fee schedule. Each surgeon files on a separate HCFA 1500 form with 51595-62, and each receives a total of 62.5 percent of the fee schedule for 51595.
  Coders can also use modifier -62 in a case that involves three surgeons, but the third physician will not be paid because modifier -62 by definition is for two co-surgeons. The general surgeon (Dr. C) may prefer this method, as long as he or she can file 51595-62. Modifier -62, under this scenario, would benefit one of the two urologists and the general surgeon. Dr. A and Dr. C would each bill 51595-62 on separate claim forms. They share a global of 125 percent of the fee for 51595. Dr. B would not be paid.

"If you do it this way, the urologist who assisted [...]