Urology Coding Alert

Question: A Medicare patient who had indigo laser treatment was seen within the 90-days global. He was seen twice in the hospital while in an observation status, and on the first day the urologist did an irrigation of clots (one hour) and simple catheter change. The diagnosis given was gross hematuria and BPH. Is this billable or is it included in the global?

Georgia Subscriber

Answer: In this case, the urologist's services are included in the global surgical package of the laser treatment (52647, Non-contact laser coagulation of prostate, including control of postoperative bleeding, complete ...). When dealing with complications of a surgical procedure, the billing for postoperative care depends on the carrier. With Medicare, payment for the treatment of a complication is only made when the patient is taken back to the operating room for a procedure. Treatments outside of the OR are not payable but are included in the Medicare surgical package.
 
With most commercial or private carriers, treatments of complications may be paid in any location. These services should be identified with modifiers -24 (Unrelated evaluation and management service by the same physician during a postoperative period) on the E/M service and modifier -79 (Unrelated procedure or service by the same physician during the postoperative period).