Urology Coding Alert

Question: A patient had cystoscopy with lithotripsy in the hospital operating room. During an office visit a week later, the physician discovered a bladder stone via cystoscopy and extracted it. I think it should be billed as 52310 (cystourethroscopy, with removal of foreign body, calculus, or ureteral stent from urethra or bladder [separate procedure]; simple) with modifier -79, but the doctor says modifier- 59 is more appropriate. Which is the correct modifier?

Pennsylvania Subscriber

Answer: Assuming this was a cystoscopy with a lithotripsy through the endoscope not an extracorporeal shock wave lithotripsy you cant bill unless its unrelated. If it is unrelated, modifier -79 (unrelated procedure or service by the same physician during the postoperative period) can be used. The -79 modifier will not reduce your charges.

Do not use modifier -59 (distinct procedural service) because the second procedure took place within the global period, not on the same day. The -59 modifier, however, will reduce the charges and is to be used to indicate that a procedure or service was distinct or independent from another service performed on the same day. This service was not performed on the same day and technically is not related to the first procedure because the purpose of lithotripsy is to pulverize the stones so they can be passed on their own. Continue coding it with modifier -79.