Urology Coding Alert

Question: A urologist performed surgery on a patient with a presacral abscess (ICD-9 567.2, Peritonitis; other suppurative peritonitis) and multiple perineal fistulae (569.81, Other disorders of intestine; fistula of intestine, excluding rectum and anus). The surgery took all day. The urologist and a general surgeon performed an abdominoperineal resection, and the urologist and a plastic surgeon drained the presacral abscess and placed bilateral gracilis myocutaneous flaps. Additonally my surgeon performed a cystoscopy. How should we code this scenario? Utah Subscriber Answer: In this case, the urologist apparently acted as an assistant surgeon for the abdominal perineal resection and myocutaneous flaps. You may code the abdominoperineal resection with 45110 (Protectomy; complete, combined abdominoperineal, with colostomy) and 15734 (Muscle, myocutaneous, or fasciocu-taneous flap; trunk) for the myocutaneous flaps.

The urologist was present for the whole surgery, assisting the general surgeon and the plastic surgeon. Therefore, you should coordinate the billing with the general surgeon's and the plastic surgeon's offices, obtaining the CPT codes they have submitted for both procedures and appending them with modifier -80 (Assistant surgeon) for proper payment.

The urologist should code independently for the cystoscopy, reporting it with no modifier. Answers to You Be the Coder and Reader Questions were provided by Michael A. Ferragamo, MD, clinical assistant professor of urology at State University of New York, Stony Brook; and Sandy Page, CPC, CCS-P, co-owner of Medical Practice Support Services in Denver.