Urology Coding Alert

Question: I'm trying to code a repair of an anastamosis of the urethra in the operating room during the global period of a radical prostatectomy. Would it be correct to report 53410 (Urethroplasty, one-stage reconstruction of male anterior urethra)? Alaska Subscriber Answer: You are definitely on the right track with CPT code 53410, but this code represents an anterior urethral repair, and another code probably more accurately reflects the procedure you describe: 53515 (Urethrorrhaphy, suture of urethral wound or injury; prostatomembranous). But don't report just code 53515. You state in your question that the repair of the urethral anastamosis was performed in the operating room during the global period, and when procedures are performed to treat complications in a global period and you are charging for them, you have three things to consider:
The carrier involved
The primary procedure's global period
Where the complication procedure was performed. Private carriers that abide by CPT's definition of the surgical package will pay for the treatment of complications in all locations, be it in the office, the hospital or the operating room. If the treatment of those complications occurs during the global period, you may need to append modifier -24 (Unrelated evaluation and management service by the same physician during a postoperative period) to evaluation and management services, modifier -79 (Unrelated procedure or service by the same physician during the postoperative period) to surgical procedures performed outside of the operating room, and modifier -78 (Return to the operating room for a related procedure during the postoperative period) to surgical procedures performed in the hospital operating room. Under these circumstances, modifier -79 can be used in the operating room or the office. The key to modifier -78 and -79 is their descriptions, "related" and "unrelated," not so much where the service was performed, although non-Medicare payers really vary as to their uses. Medicare carriers, on the other hand, will only pay for treatment of complications that require a return to the operating room, and these carriers also require you to append modifier -78 to these services.

The good news is that regardless of the carrier, you should be reimbursed for your urologist's services because the procedure performed for the complication was rendered in the hospital operating room just remember to append modifier -78.