Urology Coding Alert

Learn the rules of modifier -57 (Decision for surgery) and you will be rewarded for consultations your urologist provides during surgical procedures with 90-day global periods.

Suppose a urologist is called to the operating room by a general surgeon performing a colon resection. The general surgeon suspects he may have injured the ureter during the difficult resection. The urologist explores the ureters and finds a laceration of the left ureter. The urologist's services represent an intraoperative consultation because the surgeon requested the urologist's expert opinion and advice on the status of the patient's ureters. After the urologist confirms a laceration, he then performs the repair.

To be paid for the consultation and the resulting decision for same-day surgery, you must append modifier -57 to the consultation code, 99251-99255, says Tracy Moore, CPC, a coder with Gaston Urological Associates in Gastonia, N.C. A typical coding scenario would be 99252-57 for a level-two intraoperative consultation that resulted in a decision for ureteral repair, and 50900 and 50605-51 (Multiple procedures) if the anastomosis is stented with an open J-stent insertion. The urologist must write a consultation report separate from the operative report and place it in the patient's chart to bill a consultation code.

You probably won't be able to meet the requirements for more than a low-level consultation because the patient is not able to participate in a discussion of the history of the illness, etc., says Margaret Lamb, RHIT, CPC, a coder for Great Falls Clinic in Great Falls, Mont.

There is no national policy from CMS, says Morgan Hause, CCS, CCS-P, privacy and compliance officer for Urology of Indiana LLC, a 19-urologist practice in Indianapolis. He suggests checking with your local carrier about billing for the consultation prior to performing a surgical service. He advises coders that the patient's condition or other circumstances that prevented the physician from obtaining a history should be included in the medical record.