Urology Coding Alert

Question: An emergency room patient presented with gross hematuria and inability to void. The urologist inserted a Foley catheter and hand-irrigated his bladder. There was continuous active bleeding.
 
The patient was sent to short stay, and the next day the physician performed a cystoscopic evacuation of clots and a transurethral resection of the prostate (TURP). The patient had a TURP in 2002. How should I code this?

Oklahoma Subscriber
 
Answer: First, for the short stay you should use  99218-99220 (Initial observation care, per day, for the evaluation and management of a patient ...) appended with modifiers -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) and -57 (Decision for surgery).
 
Apply each modifier for a different reason.
 
Add modifier -25 to allow payment for the E/M service on the same day that the urologist performed a procedure (51700, Bladder irrigation, simple, lavage and/or instillation).
 
Modifier -57 indicates that the physician decided to perform surgery (52630, Transurethral resection; of regrowth of obstructive tissue longer than one year postoperative) the same day of or the day following the E/M service.
 
In addition, you should bill 51700 (Bladder irrigation, simple, lavage and/or instillation) for the irrigation of blood clots. If the urologist performed the second TURP more than one year after the first, code 52630.
 
If you perform surgery on the same day, don't charge for the admit unless a decision was made that day to do the surgery, and then you should attach modifier -57 to that admit code, and the short-stay code would not be charged.
 
Use code 52001 (Cystourethroscopy with irrigation and evacuation of multiple obstructing clots) and append modifier -59 (Distinct procedural service) if the irrigation was for multiple obstructing clots and took a significant time to clear all the clots. You need modifier -59 to unbundle 52001 from 52630.

 - Answers to You Be the Coder and Reader Questions contributed by Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology, State University of New York, Stony Brook, New York; and Morgan Hause, CCS, CCS-P, privacy and compliance officer for Urology of Indiana LLC, a 19-urologist practice in Indianapolis.