Urology Coding Alert

When a urologist brings a patient back to the operating room (OR) within the global period of the first procedure, he or she may use one of three modifiers. Whether to use modifier -78 (return to the operating room for a related procedure during the postoperative period), modifier -79 (unrelated procedure or service by the same physician during the postoperative period) or modifier -58 (staged or related procedure or service by the same physician during the postoperative period) depends on the reason for the second procedure. The modifier you choose affects how much you will be paid for the second procedure.
Use Modifier -78 for Complications  
If the patient returns to the OR for surgical treatment of a postoperative complication within the global period of the primary surgery, the urologist should bill the procedure that rectifies the complication. The coder must add modifier -78 to the second procedure to indicate that this was an operative treatment of a complication in the OR. The urologist will be reimbursed for only the intraoperative percentage of that procedure, with no fee for pre- or postoperative services. Using modifier -78 generally reduces the procedure fee of the surgery to 60 to 75 percent of the fee schedule. The urologist will not start a new global period with the second procedure.
 
For example, a urologist performs a transurethral resection of the prostate (TURP). The patient does well for three days until he starts bleeding. The physician brings the patient back to the OR and fulgurates the bleeding blood vessel within the prostatic fossa. Bill 52214 (cystourethroscopy, with fulguration [including cryosurgery or laser surgery] of trigone, bladder neck, prostatic fossa, urethra, or periurethral glands) and append modifier -78. The urologist will not begin a new global period with this procedure.
 
Under Medicare rules, treatment for complications outside of an OR -- such as a hospital bed, an office or an emergency room -- is not a payable service and is included in the global package.
 
If the urologist treats a complication in the office, the coder can't bill it with modifier -78. For example, a patient who had a TURP and is bleeding three days later may come in for an office visit. The urologist places a catheter and irrigates the patient out. Because the procedure did not take place in the OR, the physician cannot bill for it.  
 
The urologist can use the same diagnosis for the first and second procedures. Modifier -78 does not require a separate diagnosis.
Modifier -79 for Unrelated Procedure  
Use modifier -79 for an unrelated procedure performed during the global period of another procedure.
 
For example, a patient undergoes TURP and does well. The urologist sees him in the office a month later, and [...]