Urology Coding Alert

Question: My doctor saw a patient in the office and performed a cystoscopy (52000). He then took the patient to the hospital that same day for a TURP of regrowth tissue. Should I add a modifier to the TURP to overcome the bundling with the cystoscopy? I was thinking either modifier 58 since it was staged at the time of the cystoscopy due to the findings or modifier 59 since it was a different session.

Virginia Subscriber

Answer: Unfortunately, the Correct Coding Initiative (CCI) edits bundle 52000 (Cystourethroscopy [separate procedure]) into 52630 (Transurethral resection; residual or regrowth of obstructive prostate tissue including control of postoperative bleeding, complete [vasectomy, meatotomy, cystourethroscopy, urethral calibration and/or dilation, and internal urethrotomy are included]), and you cannot break this bundle with any modifier. Therefore, for the clinical scenario you describe just report 52630. 

Reasoning: Since payers reimburse on a per full day basis and do not distinguish between procedures performed at different times on the same day, you will not be paid for the cystoscopic examination performed on the same day as the prostatectomy even though it was at a separate encounter.