Urology Coding Alert

Question: Can I charge for a catheter insertion (CPT 51702 ) if the patient just had a bladder sling two days ago, or would this be considered in the global period of the sling procedure?

North Carolina Subscriber

Answer: The answer will depend on where the patient underwent the catheter insertion.

Why: When CMS revised the definition for modifier 78 (Unplanned return to the operating/procedure room by the same physician following initial procedure for a related procedure during the postoperative period), the addition of the word "procedure room" indicated a procedure room within the hospital, such as a GI lab or cardiac catheterization room, where a patient may return for further surgery to care for a postoperative surgical complication. Unfortunately, this does not include a room in the office that you may designate as a procedure room.

Medicare, therefore, continues to pay for the treatment of a postoperative complication only when a patient is returned to the hospital operating room or an in-hospital procedure room.

Alternative: Many private carriers will pay for the treatment of postoperative complications whether the care takes place in the office or hospital. Both medical and surgical care may be paid. Add modifier 24 (Unrelated E/M service by the same physician during a postoperative period) if you're billing an E/M service for medical care of a postoperative complication and add modifier 79 (Unrelated procedure or service by the same physician during the postoperative period) to a surgical care code, such as 51702, for surgical care of a postop complication.