Urology Coding Alert

Question: A patient with gross hematuria and a history of TCC (transitional cell carcinoma) of the bladder, cancer of the prostate, status post (physical status of patient after treatment of a condition) TURP (transurethral resection of prostate) and bilateral retrogrades (cystoscopic examination of both ureters against the urine flow) and TURBT (transurethral resection of bladder tumors) comes in for a post-op visit. The physician goes over the pathology report findings (cancer-recurrent) and makes recommendations concerning treatment to the patient. What modifier, if any, may be used to properly bill for this cancer consultation?

California Subscriber

Answer: All evaluation and management (E/M) visits with a surgeon related to a particular surgery that occur within the global period of the surgery are considered part of the global surgical payment and are not separately reimbursable. This would include visits regarding the operative findings and treatment recommendations. Only E/M visits unrelated to the surgery could be submitted with a modifier -24 (unrelated evaluation and management service by the same physician during a postoperative period).