Urology Coding Alert

Question: If a physician performs urodynamics in the office within the global time period of a TVT, and he performed the urodynamics due to a recurrence of USI after the procedure, would it be appropriate to add modifier 78 because these procedures fall into the diagnostic category?

Michigan Subscriber

Answer: This is a question that may not have one specific answer. If you determine that the urodynamics represent an evaluation of a complication from the transvaginal tape (TVT) sling operation, then Medicare  will not consider the evaluation and subsequent treatment of the complication to be a billable service if your urologist performs these services out of the operating room. Since your urologist performed the service in the office, you won't be able to bill Medicare In your clinical scenario you should consider the reoccurrence of urinary stress incontinence a failure of the operative procedure rather than a complication. In general, most physicians, in order to maintain a favorable and satisfactory physician-patient relationship, will not charge for repeat services in a global period-- especially when an initial therapeutic procedure has failed. This decision, however, should always be made by the urologist and not by you as the coder.

For non-Medicare carriers who do not follow Medicare policy or coding rules, you may decide to bill for the urodynamic studies performed in the office with modifier 79 (Unrelated procedure or service by the same physician during the postoperative period) appended to each urodynamic CPT code.

Caution: You can only append modifier 78 (Unplanned return to the operating/procedure room by the same physician following initial procedure for a related procedure during the postoperative period) to a code if your physician returned the patient to the operating room.

Alternative: Many times the urodynamics performed in the postoperative period are to diagnose a new problem that may have resulted from the sling procedure, such as an overactive bladder. Under these circumstances, for the studies performed in the office, append modifier 79 to each urodynamic code for both Medicare and private carriers. The new diagnosis would be 596.51 (Hypertonicity of bladder).

Tip: Modifier 58 (Staged or related procedure or service by the same physician during the postoperative period) may also be appropriate when appended to the urodynamic studies, so base your choice on the clinical circumstances. Either modifier will ensure full payment for the urodynamic studies performed in a global period.