Urology Coding Alert

Question: The urologist saw a patient who began experiencing slowing of his urinary stream one month after a seed implantation for carcinoma of the prostate and bladder stone removal. The urologist performed a urodynamics study to check the patient's bladder function. The physician didn't plan the urodynamics study at the time of surgery. Should I append modifier 58?

Rhode Island Subscriber

Answer: Since the needle insertions into the prostate gland have a 90-day global period, you will need a modifier to be paid for covered services done in the postoperative global period. In addition, you're correct to question modifier 58 (Staged or related procedure or service by the same physician during the postoperative period).

Modifier use: Instead, you should consider modifier 79 (Unrelated procedure or service by the same physician during the postoperative period) since the diagnosis for the urodynamics study was likely different from the ones for the initial procedures -- carcinoma of the prostate (185) and bladder stone (594.1). For example, the diagnosis may be an atonic bladder (596.4, Atony of bladder) or a neurogenic bladder (596.54, Neurogenic bladder NOS).

The urodynamic testing should be a payable service as it is a diagnostic test which your urologist performed within the global period. Diagnostic studies, such as urodynamics, radiological studies (ultrasounds), and laboratory studies are all payable services within the global period. Some, however, such as urodynamics, require a modifier for payment.

Caveat: If your urologist routinely performs urodynamic studies during the global period of procedures, rather than for further evaluation of a new problem, then you should not be coding for the urodynamic services at all.