Urology Coding Alert

Question: The urologist performed a transrectal finger-guided biopsy of the prostate because of an elevated PSA. He also performed a TURP for BPH. Would modifier XS be appropriate for this claim, or should we report modifier 79?

Maryland Subscriber

Answer: Your first step in reporting this encounter is to consider the procedure codes for what the urologist performed. You will report 55700 (Biopsy, prostate; needle or punch, single or multiple, any approach) and 52601 (Transurethral electrosurgical resection of prostate, including control of postoperative bleeding, complete (vasectomy, meatotomy, cystourethroscopy, urethral calibration and/or dilation, and internal urethrotomy are included)).

Pay attention: Remember that code 55700 is bundled into code 52601, but the pair can be unbundled and you can be reimbursed for both procedures in certain situations, if you have supporting documentation and append a modifier to distinguish services. In this clinical scenario, append modifier XU (Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service) to 55700 to represent the needle biopsy of the prostate in conjunction with the TURP (52601).

The correct ICD-10-CM diagnoses would be R97.20 (Elevated prostate specific antigen (PSA)) for 55700 and N40.1 (Benign prostatic hyperplasia with lower urinary tract symptoms) for 52601.