Urology Coding Alert

Question: Our urologist performed a bladder suspension at the same surgical encounter that a gynecologist performed a hysterectomy. How should I bill?

Wisconsin Subscriber
Answer: The answer depends on how the hysterectomy was performed and what type of bladder suspension was added.
 
For an abdominal hysterectomy and Marshall-Marchetti-Krantz (MMK) suspension, use 58152 (Total abdominal hysterectomy [corpus and cervix], with or without removal of tube[s], with or without removal of ovary[s]; with colpo-urethrocystopexy [e.g., Marshall-Marchetti-Krantz, Burch]) with modifier -62 to indicate two surgeons. Each will receive 62.5 percent of the global fee.
 
For a vaginal hysterectomy and sling procedure, the gynecologist uses 58260 (Vaginal hysterectomy) or 58262 ( with removal of tube[s], and/or ovary[s]). The urologist codes 57288 (Sling operation for stress incontinence [e.g., fascia or synthetic]). Each should submit for his or her procedure and will be paid the full fee.
No modifiers are needed.
 
For a vaginal hysterectomy and an MMK or similar procedure, bill 58267 ( with colpo-urethrocystopexy [Marshall-Marchetti-Krantz type, Pereyra type, with or without endoscopic control) with modifier -62. Each will receive 62.5 percent of the global fee.
 
With modifier -62, each surgeon dictates his operative work separately and indicates what the other surgeon did. Each submits an identical claim form and the operative report via paper transmission. Expect a medical review and delayed payments.
 
Modifier -62 requires that both surgeons be present for the majority of the operative session.
  Answers contributed by Michael A. Ferragamo, MD, clinical assistant professor of urology, State University of New York, Stony Brook; Sandy Page, CPC, CCS-P, co-owner, Medical Practice Support Services, Denver; and Morgan Hause, CCS, CCS-P, coding specialist, Urology of Indiana, Indianapolis.