Urology Coding Alert

Question: Our physician was called in during a hysterectomy to confirm or deny the presence of ureteral damage. After exploration of the ureter, the physician determined there had been no damage. Can we bill for this?

New Hampshire Subscriber

Answer: The scenario in question is a common one that can be handled correctly only with proper use of two modifiers: -57 (Decision for surgery) and -52 (Reduced services).

Let's break down the situation into a first and second half. The first half is the surgeon's, or in this case, the gynecologist's, request for your urologist's opinion.

Consider the request for opinion and subsequent evaluation of the patient by the physician an intraoperative consultation, which should be coded 9925x-57, depending on the level of consult documented. In most cases, you will only be able to bill a low-level consultation because the urologist won't be able to take a detailed history, etc.

The second half of the scenario consists of the ureteral exploration. For the surgical ureteral exploration, use code 50600 (Ureterotomy with exploration or drainage [separate procedure]) and append modifier -52 to indicate a reduced service because no ureterotomy was performed or deemed necessary.

Another option is to consider billing the physicians as surgical assistants in the scenarios where no damage is found, and to bill the surgeons with the same code as the primary surgeon, appending modifier -80 (Assistant surgeon).