Urology Coding Alert

Question: Our physician was called in to perform bladder repair on a patient undergoing an abdominal hysterectomy. How should we bill for our urologist's intraoperative service?

California Subscriber

Answer: There are two potential methods to code the bladder repair, depending on the degree of consultation required of the urologist.

If the gynecologist performing the hysterectomy and cystotomy informs your doctor of the laceration of the bladder that must be closed, you cannot bill for a consultation. Therefore, you should code 51860 (Cystorrhaphy, suture of bladder wound, injury or rupture; simple) for a simple procedure, or 51865 ( complicated) if the procedure can be considered complicated.

If the gynecologist cannot determine if a laceration has occurred, and your doctor is called in for his opinion as to the presence of and the extent of any injury, you can bill for a consultation in addition to the repair procedure.

To correctly identify consultations, remember the three R's: a Request for consult, a Rendered opinion, and a written Report. You should use 9925x and append modifier -57 (Decision for surgery) to the appropriate procedure code if surgery is deemed necessary modifier -57 is always placed on an E/M service. If there is no deduced bladder damage, you should q only for the consultation.