Urology Coding Alert

Assigning the proper procedure code for services your urologist provides is often only half the battle. If you're not appending the proper modifier -- or if you're assigning the wrong modifier -- you risk miscoding and denials. Size up your modifier know-how with these five questions, and then see if your answers match the experts' answers.

Question 1: The urologist performs a radical retro-pubic prostatectomy and unilateral node dissection. How should you report this procedure?

Question 2: Your urologist sees a patient in his office for a level-three new patient visit. He performs a urin-alysis without microscopic evaluation and an in-office cystoscopy to evaluate the patient's gross hematuria (599.89). Which codes and modifiers do you need for this visit and procedure?

Question 3: Your urologist performs a complete cystectomy and an ileal conduit with a bilateral pelvic node dissection in a patient who has had previous pelvic radiation leading to extensive pelvic adhesions. The urologist must perform an extensive lysis of these adhesions before he proceeds with the operation, and this leads to a marked increase in the operating time.

Which modifier should you use to seek additional reimbursement for the physician's extra time and work?

Question 4: Your urologist performs surgery with a general surgeon as his co-surgeon. They perform a total cystectomy, ileal conduit, bilateral pelvic lymphadenectomy, indwelling stent insertion, and hysterectomy. How should you report this procedure for each of the surgeons, making sure to append the proper modifiers?

Question 5: A patient undergoes a transurethral resection of the prostate (TURP). Thirteen days later the patient comes into your office with flank pain, and your urologist diagnoses renal colic. How should you report these two services to ensure payment for both? Should you even bill for the postoperative office visit?