Urology Coding Alert

Question: If a patient comes to the office following a TURP and the nurse practitioner does self-catheter training with the patient that lasts for more than 30 minutes, is this a reportable service? The NP knew the patient would need to come in. Would modifier 58 come into play here?


Kansas Subscriber

Answer: The coding for this scenario depends on the clinical circumstances of the intermittent catheterization. If this was a planned therapy/procedure to follow the transurethral resection of the prostate (TURP), you should just report the catheterization using 51701 (Insertion of non-indwelling bladder catheter [e.g., straight catheterization for residual urine]). Add modifier 58 (Staged or related procedure or service by the same physician during the postoperative period) to indicate the planned nature of this secondary surgery.

Caution: In this case, the office visit falls within the 90-day global of the TURP, so you should not charge separately for this E/M service.

Option 2: If the catheterization is a new treatment offered after the TURP procedure and the physician did not plan for the service beforehand, report the E/M service 9921x (Office or other outpatient visit for the evaluation and management of an established patient ...). Append modifiers 24 (Unrelated evaluation and management service by the same physician during a postoperative period) and 25 (Significant, separately identifiable E/M  service by the same physician on the same day of the procedure or other service).

You should also report 51701 with modifier 79 (Unrelated procedure or service by the same physician during the postoperative period) attached indicating the urologist performed a new treatment during the postoperative care of the TURP.