Urology Coding Alert

Question: In October, a patient had extracorporeal shock wave lithotripsy, which carries a 90-day global. This was for a ureteral stone. The patient returned in December with pain and an x-ray showed the stone unchanged in the ureter. Therefore, the urologist performed a ureteroscopy and stone extraction. I billed this to the insurance with a 58 modifier, but it is being denied. How should I be coding instead?Answer: You are still in the 90-day global of the extracorporeal shock wave lithotripsy (ESWL), but you are now providing a more invasive surgical procedure. Your coding for the treatment of the same stone that remains in the same location in the ureter and appears to have not been fragmented by the ESWL is correct coding.Use modifier 58 (Staged or related procedure or service by the same physician during the postoperative period) to indicate the more invasive nature of the present treatment, the [...]