Urology Coding Alert

Question: I placed a mid urethral sling 57288 on a patient on 1/14/15. This was at the same time as a hysterectomy by a gynecological surgeon. The other surgeon requested that I perform cystoscopy for a possible right ureteral injury at the time of his surgery. This led to a retrograde pyelogram, which revealed a transected ureter. I then performed a right ureteral reimplant.

Are 52005 and 50780 the correct codes to report? If the ureteral reimplant was emergent and caused me to cancel my entire practice that day, is there a modifier I can use to seek extra payment? How can I also get paid fully for the sling, which is a completely unrelated diagnosis rather than get a 50 percent reduced rate for multiple procedures. The sling was scheduled and unrelated to the emergent procedure.

California Subscriber

Answer: The proper coding for your scenario would be the following:

• 50780 (Ureteroneocystostomy; anastomosis of single ureter to bladder) for the ureteral re-implantation of the transected ureter, with diagnosis codes 867.2 (Injury to ureter without open wound into cavity) and 998.2 (Accidental puncture or laceration during a procedure not elsewhere classified) — 100 percent reimbursement

• 57288 (Sling operation for stress incontinence [eg, fascia or synthetic]) for the sling placement, with diagnosis code 625.6 (Stress incontinence female) — 50 percent reimbursement

• 52005 (Cystourethroscopy, with ureteral catheterization, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service) for the retrograde pyelogram, with diagnosis code 998.2 — 50 percent reimbursement.

There are no special modifiers you can use to seek additional pay because of the clinical circumstances.