Urology Coding Alert

Trap: Don't think 58 is just for advanced planning Still confused about which postsurgical modifier to use on claims despite the CPT Codes 2008 revisions? You're not the only one. Despite the fact that CPT 2008 revised the text explaining modifier 58 (Staged or related procedure or service by the same physician during the postoperative period), many practices are still confused about how to interpret modifier 58 and when to use it rather than modifier 78 (Unplanned return to the operating/procedure room by the same physician following initial procedure for a related procedure during the postoperative period). Move beyond the confusion and ensure you're coding every postsurgical procedure correctly with these expert tips. Tip 1: Don't Rely on Planning This year, CPT advised that you may append modifier 58 to staged or related procedures that were "planned or anticipated" at the time of the original surgery -- not just ones that your surgeon planned in advance. Caution: The new description doesn't mean that you should automatically apply modifier 58 to all foreseen secondary procedures and append modifier 78 for unplanned postsurgical procedures. Bottom line: You should apply modifier 58 when a procedure or service during the postoperative period is: • planned prospectively at the time of the original procedure (staged), or • more extensive than the original procedure, or represents surgical treatment following a diagnostic surgical procedure. "The current procedure has some connection to the original procedure, be it a more extensive approach to the original procedure or planned services after the original procedure (surgery or therapeutic treatment)," says Edwina Sprow, CPC, owner of Sprow Consulting Services based in Phoenix. Example: The urologist performs a transurethral resection of the prostate (TURP) for benign prostatic hyperplasia (BPH). Because of the large size of the prostate gland, the initial procedure is incomplete, and in his op note, the urologist indicates that the patient will need a second-stage TURP to remove more tissue at a later date. The patient returns to the operating room 41 days later for another TURP because of the persistent BPH. In this case, you report the first TURP using 52612 (Transurethral resection of prostate; first stage of two-stage resection [partial resection]). Then, because the urologist said that the patient would require a second- stage resection during the 90-day global period of the first resection, you should code the second TURP as 52614 (Transurethral resection of prostate; second stage of two-stage resection [resection completed]). Append modifier 58 to indicate a staged procedure and ensure full payment for the second TURP within the 90-day global of the first. Important: Payers require that documentation in the initial op note should indicate that a second staged procedure will be necessary. This prospectively [...]