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Urology Coding Alert

Reader Questions:

Capture Extra Pay With Modifier 22

Published on Tue Mar 16, 2010

Question: My urologist did an open abdominal exploration with cystotomy and removal of exposed mesh that had eroded through the patient's bladder. He also removed adherent stone material on the mesh. How should I code this procedure? Ohio Subscriber Answer: Report 51050 (Cystolithotomy, cystotomy with removal of calculus, without vesical neck resection) for the mesh and stone removal from within the bladder. Additionally: If the removal was complicated and extended the surgery a significant period of time, you should consider appending modifier 22 (Unusual procedural services) to 51050. Remember that your payers won't accept a modifier 22 claim unless you can provide convincing evidence both in the operative report and the cover letter that the service or procedure was truly "out of the ordinary" and significantly more difficult or time-consuming than a usual 51050 procedure. -- Answers to Reader Questions and You Be the Coder contributed by Michael A. Ferragamo, [...]
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