Urology Coding Alert

Urology coders are often confused about how to code when a laparoscopic procedure switches to an open procedure. Urologists can spend a lot of time on a laparoscopy, but they cant necessarily bill for both laparoscopic and open codes. To receive proper payment, coders can append modifiers -52 (reduced services) or -53 (discontinued procedure) to the laparascopic code and bill the open code as well, or they can append modifier -22 (unusual procedural services) to the open code.

For example, a urologist attempts a radical nephrectomy via laparoscopy (50545), but because of technical difficulties with the dissection, the urologist converts to an open radical nephrectomy (50230).

Use Modifier -52 or -53

According to CPT guidelines (March 2000 CPT Assistant), surgeons should bill the laparoscopic procedure with modifier -52 or modifier -53 appended, and the open procedure.

Coding a converted laparoscopic to open procedure requires a review of the operative report to determine how much of each procedure was performed. The same review is required when coding any attempted procedure. Modifier -52 should be used when the urologist switches from laparoscopic to open at the physicians discretion. Modifier -52 signals that the conversion is done by doctor choice, says Laura Siniscalchi, RHIA, CCS, CCS-P, CPC, senior consultant with the Boston branch of Deloitte and Touche, a national auditing consultancy. CPT says to use modifier -52 if its your choice to convert to open, Siniscalchi says. The urologist will be paid about half of the fee for the laparoscopy portion of the bill, Siniscalchi says. For example, the open radical nephrectomy (50230) would be paid in full, and the laparoscopic portion (50545-52) would be paid at about 50 percent.

Modifier -53 does not necessarily result in a payment reduction, and should be used when the urologist discontinues the laparoscopic procedure because of extenuating circumstances that threaten the well-being of the patient. Do not use modifier -53 for the elective cancellation of a procedure prior to the patients anesthesia induction and/or surgical preparation in the operating suite, according to CPT 2001. Again, with reference to the nephrectomy scenario, if the urologist forgoes the laparoscopic radical nephrectomy and converts to an open procedure to control excessive bleeding, and subsequently performs an open nephrectomy, code 50230 and 50545-53.

Local Carriers Policies

Coders who have worked outside of urology get confused because they know Medicare carriers say to bill only the open code for cholecystectomies that convert from laparoscopic to open. But coders should not assume a carrier has the same rules for urological procedures as for cholecystectomies. A radical nephrectomy is not [...]