Urology Coding Alert

Answer: There are two factors you should consider when billing this discontinued procedure: the cost of the catheters used to begin the transurethral microwave thermotherapy of the prostate, and the likelihood that the procedure will be reattempted on the same patient by the same physician within the subsequent 90-day period.

The likelihood that the patient will return for another shot at the TUMT procedure presents the coder with the problem of coding the initial procedure in a way that makes the next attempt reimbursable by Medicare and third-party payers.

The solution can be found in modifier -53 (Discontinued procedure). Medicare will adjust the payment for the initial procedure, and most Medicare carriers will remove the global period from the initial procedure when you append modifier -53. Therefore, if and when you do the same procedure on a later date, you will not need to worry about appending any modifiers to indicate that the procedure is billable.

In contrast, some private and HMO carriers will require the use of modifier -58 (Staged or related procedure or service by the same physician during the postoperative period) with the repeated procedure if it is provided during the 90-day global period because not all carriers recognize modifier -53.