Urology Coding Alert

Question: Ten days after an open simple prostatectomy, the urologist brought the patient back to the OR for bladder clots. He performed a cystoscopy with clot evacuation and a transurethral resection of residual prostatic tissue along with fulguration of prostate urethral bleeders. Four days later, he brought the patient back to the OR again for bladder clot retention. He did another cysto with evacuation of bladder clots and fulguration of prostate urethral bleeding points. What's the proper coding for this scenario?

Montana Subscriber
 
Answer: All of the procedures you describe would be considered care for postoperative complications and thus within the global period of the prostatectomy. You will therefore need to append modifier -78 (Return to the operating room for a related procedure during the postoperative period) to the procedure codes.
 
Day 1: For the first date of service, 10 days after the initial prostatectomy, report 52614-78 (Transurethral resection of prostate; second stage of two-stage resection [resection completed]) for the partial TURP and fulguration of the prostatic fossa.
 Also, you should report 52001-59-78 (Cystourethroscopy with irrigation and evacuation of multiple obstructing clots; distinct procedural service) for the cystoscopy and evacuation of clots. Only use this code if the patient had clot urinary retention, and this procedure entailed a lot of time over and above the transurethral prostatectomy. Append modifier -59 to 52001 to break it from the NCCI bundle with 52614.
 
Day 2: For the second date of service, again report 52001-59-78 for the second cystoscopy and evacuation of clots and 52214-78 (Cystourethroscopy, with fulguration [including cryosurgery or laser surgery] of trigone, bladder neck, prostatic fossa, urethra or periurethral glands) for the second fulguration of the prostatic fossa.
 
Again add modifiers -59 and -78 to break the bundle with 52214 and to indicate that this is postoperative care in the OR for a postoperative complication.

 - 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; and Morgan Hause, CCS, CCS-P, privacy and compliance officer for Urology of Indiana LLC, a 31-urologist practice in Indianapolis.