Urology Coding Alert

Question: A patient had a TURP in January. He came to the office in late March complaining of voiding difficulties. We coded for the office visit, a cysto (using CPT code 52000) and a percutaneous suprapubic cystotomy (with 51010). Medicare denied the claim as being within the global of the TURP. The urologist says this was not a complication of the surgery, however. How can I correctly code this claim?


Virginia Subscriber

Answer: If your urologist believes that the post-TURP problems are not complications of the surgery and can defend this point if necessary, then you may code for the E/M service with modifier 24 (Unrelated evaluation and management service by the same physician during a postoperative period) appended.
 
For the procedures, report 52000 (Cystourethroscopy [separate procedure]) and 51010 (Aspiration of bladder; with insertion of suprapubic catheter) with modifier 79 (Unrelated procedure or service by the same physician during the postoperative period) appended to both. For these procedures, the urologist should have ICD-9 codes different from the diagnosis for the TURP.

If he believes these are complications of the previous surgery within the global of the TURP, and this patient is covered by Medicare insurance, then these services are not chargeable services if the urologist performed them in the office.

For private carriers, many of whom will reimburse for treatments of all postoperative problems outside of a normal smooth postoperative course, code as above for payment for these services.