Urology Coding Alert

Question: Is there a procedure code that can be used when a cystourethroscopy exam is discontinued or do I charge for an exam in the operating room (OR) because this is where it was to be performed?

Virginia Subscriber

Answer: If the patient is taken to the OR and the physician did not perform the procedure due to life-threatening circumstances, you would bill 52000 (cystourethroscopy [separate procedure]) with modifier -53 (discontinued procedure). This tells the insurance company that the patient was in the OR and prepped but the surgery was cancelled for the well-being of the patient. Bill at the regular fee schedule and let the insurance company make the reduction. Modifier -52 (reduced services) should be used if the procedure was canceled for some reason other than the general well-being of the patient.

Answers were contributed by Ray Painter, MD, president, PRS, Denver; Sandy Page, CPC, CCS-P, co-owner, Medical Practice Support Services, Denver; Mary T. Bland, CPC, coding consultant, Mesa, Ariz.; and Kathy Zmuda, CPC, lead inpatient coder, Cigna Health Care of Arizona, Phoenix.