Urology Coding Alert

Question: My urologist started a lap prostatectomy. Mobilizing the bladder revealed a high prostate with limited working space for dissection. Given the patient's morbid obesity, limited working space, and the patient's age, the urologist determined it was best to abort the procedure. Is there a separate code for bladder mobilization or would we just use 55866-53 for the aborted prostatectomy?

Florida Subscriber

Answer: You are correct to report the prostatectomy code with a modifier. You should report 55866 (Laparoscopy, surgical prostatectomy, retropubic radical, including nerve sparing). Append modifier 53 (Discontinued procedure) to indicate that the urologist aborted the procedure for the patient's well-being.

Why: Your urologist started the procedure, and did a part of the procedure, but because of extenuating circumstances, he terminated the procedure. This would certainly qualify as a proper time to use modifier 53.

Stopped, not reduced: Don't confuse modifier 53 with modifier 52 (Reduced services). To apply modifier 52, the reduction of services must have occurred by choice (either the physician's or the patient's) rather than necessity. When you use modifier 52, you're telling the payer that the urologist completed the procedure, although not the full procedure indicated in the CPT code descriptor.