Urology Coding Alert

Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.


Question: How do I code the exploration of the suprapubic space in an attempt to do a suprapubic cystostomy? I have billed Medicare several times using the code for suprapubic cystostomy with modifier -52 (reduced services) and modifier -22 (unusual procedural services). I have filed this claim and sent the operative report with it. The doctor stated that the procedure was terminated due to the risk involved. How would you code this?

Florida Subscriber


Answer: Modifier -52 is for a reduced service or a discontinued procedure, and would be the correct modifier for this case if the risk involved was not life- threatening. The correct modifier for a procedure that is discontinued for a life-threatening reason is modifier -53. The descriptor for modifier -53 states that Due to extenuating circumstances or those that threaten the well being of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued.

With modifier -52, the procedure was performed, but the extent of the procedure was reduced in some fashion at the discretion of the physician. With modifier -53 the surgery was terminated because of a life-threatening situation for the patient. You would not use -53 if the patient had not yet received anesthesia or surgical prep.

Your documentation of the procedure would include the operative note and documentation that indicated the extent of the procedure that was performed and the circumstances that caused it to be terminated.

Usually, modifier -53 is reserved for a life-threatening situation related to anesthesia. These would be extenuating circumstances beyond the surgeons control. If the surgeon ran into complications, or couldnt get the catheter in, or found something else that indicated that he shouldnt pursue the cystotomy at that time, the correct modifier would be -52.

It is not necessary to use the -22 modifier, which typically indicates that the surgical procedure was more intensive than usual. Based on your question, the service was not performed at all and, therefore, was not more intensive. Use of the modifier -22 may be causing more confusion. If you meet the criteria for the -53 modifiermeaning that the risk was life-threateningyou should refile the claim with the correct modifier or review payment with the carrier.