Urology Coding Alert

Question: Several days after a total cystectomy and continent urinary diversion, a patient underwent an abdominal exploration for an acute abdomen, acidosis, elevated white cell count, and ileus. The post-op diagnosis was small bowel perforation/leak. My urologist and a general surgeon performed an exploratory laparotomy,lysis of adhesions, small bowel resection, repair of ileal neobladder perforation, revision (redo) of ureteroileal anastomosis, pelvic drain, and wound irrigation. The general surgeon performed the small bowel resection. The urologist performed the neobladder and ureteral repair.For my urologist, can I use the unlisted procedure code for revisions of the ileal neobladder and ureteroileal anastomosis? Also, can I still code for exploratory laparotomy and the lysis of adhesions? Are these codes bundled into the bowel resection and anastomosis?

Indiana Subscriber

Answer: You should report 44602 (Suture of small intestine [enterorrhaphy] for perforated ulcer, diverticulum, wound, injury or rupture; single perforation) for the repair of the neobladder perforation.

Next, report 50800 (Ureteroenterostomy, direct anastomosis of ureter to intestine) for the reimplantation of the ureter into the bowel. Append modifier 51 (Multiple procedures) to show the payer that your physician performed more than one procedure during the same session.

Keep in mind: Modifier 51 is an informational-type modifier for use on the second, third, etc., surgical procedure performed on the same day as another procedure you are reporting. Many payers no longer require modifier 51.Processing claims electronically allows the payer to recognize when your physician performs multiple procedures and automatically makes the necessary reduction in payment. Remember to always list the highest-paying procedure code first, in this case 44602.

Since it appears that your urologist performed these procedures in the global period of the initial diversionary procedure, you should add 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 each of the codes, indicating treatment in the operating room of complications resulting from the original surgery.

Note: The abdominal exploration and lysis of adhesions are included in the above coding and you should not separately report them.

-- Answers to Reader Questions and You Be the Coder contributed by Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology, State University of New York, Stony Brook.