Urology Coding Alert

Question: A urologist from another practice performed a TURP on a patient (52601). Three days later the patient went to the emergency room in acute urinary retention secondary to continued prostatic enlargement. Our urologist was called to consult and then took the patient back to the OR. Our urologist performed another TURP because the patient’s prostate was still large. Should I attach either modifier 77 or 78 to our claim?

California Subscriber

Answer: If your urologist was providing reciprocal coverage for the initial urologist, (an arranged on-call schedule for the first urologist) code as if your urologist was the primary urologist. In this clinical scenario report 52630 (Transurethral resection; residual or regrowth of obstructive prostatic tissue, including control of postoperative bleeding, complete (vasectomy, meatotomy, cystourethroscopy, urethral calibration and/or dilation, and internal urethrotomy are included)) for your physician’s work. Append modifier 77 (Repeat procedure by another physician or other qualified health care professional).

If your physician was not providing reciprocal coverage, bill 52630 but without modifier 77 or 78 as your urologist is unrelated to and not a partner of the initial surgeon and is not restricted under his global period.

Here’s why: A provider may perform a repeat procedure because the patient did not respond well to the first procedure or because the first procedure was not successful. If procedure was repeated by another physician subsequent to the original procedure, then this circumstance is reported by adding modifier 77 to the repeated procedure. A repeat TURP as in this case should be reported using 52630 instead of 52601 (Transurethral electrosurgical resection of prostate, including control of postoperative bleeding, complete (vasectomy, meatotomy, cystourethroscopy, urethral calibration and/or dilation, and internal urethrotomy are included)).

The key terms related to modifier 78 (Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period) are “unplanned” and “same physician or other qualified health care professional.” The unplanned procedure may be the result of a complication that the initial procedure caused, but it is not considered to be a repeat procedure (which is what you’re coding). Also, in order to report modifier 78, the same provider must complete both the initial procedure and the unplanned follow-up procedure.