Urology Coding Alert

Question: Two urologists worked on a case, but neither was present for the other physician’s part of the surgery. Doctor 1 completed a laparoscopic bladder removal, then Doctor 2 performed an open ileal loop. They were both primary surgeons on the total case but performed distinct parts of the entire procedure. How should I code their work?

Nevada Subscriber

Answer: You can report the two procedures separately:

• Doctor 1 – Submit 51999 (Unlisted laparoscopy procedure, bladder) for the laparoscopic radical cystectomy
• Doctor 2 – Submit 50820 (Ureteroileal conduit [ileal bladder], including intestine anastomosis [Bricker operation]) with modifier 50 (Bilateral procedure) appended for the open ileal conduit with bilateral ureteral implan­tations into the conduit.

The above procedures do not represent “co-surgery.” The term “co-surgery” refers to a single surgical procedure that requires the skills of two surgeons and for Medicare each in a different specialty, performing parts of the same CPT^® procedure at the same encounter. Because the surgeries you describe are separate procedures and because both physicians were urologists, there is no need to append modifier 62 (Two surgeons) to either claim.