Urology Coding Alert

Question: If a patient has a TURP (52601) and 14 days later has urinary retention, is this considered a post operative complication? Can I bill 51702 and 51798?

California Subscriber

Answer: Yes, you should consider urinary retention after a transurethral resection of the prostate (TURP) as a complication of the TURP. Code 52601 (Transurethral electrosurgical resection of prostate, including control of postoperative bleeding, complete [vasectomy, meatotomy, cystourethroscopy, urethral calibration and/or dilation, and internal urethrotomy are included]) carries a 90-day global period, so you are dealing with complications within the global period of the procedure, since the retention occurred 14 days after the surgery.

The problem: Medicare will only pay for the treatment of a complication when your urologist returns the patient to the operating room (OR). In that case, you have to add modifier 78 (Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period) to the surgical code. For your scenario, if the urologist returned the patient to the operating room, report 51702 (Insertion of temporary indwelling bladder catheter; simple [eg, Foley]) with modifier 78. Within the global period of the TURP (51601) if the urologist did the procedure in his office, you cannot bill 51702.

However, remember that many non-Medicare payers will reimburse for the treatment of a complication whether the treatment takes place in the office or OR.

In your scenario, if you are billing a private payer, report 51702 with modifier 79 (Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period) attached, if the catheter is placed in the office, and 51702-78 if placed in the operating room.

You should be able to bill 51798 (Measurement of post-voiding residual urine and/or bladder capacity by ultrasound, non-imaging) for both Medicare and non-Medicare payers in any location (office or hospital) as this is a radiology code and is not included within a global period.

Here’s why: The global concept does not apply to radiology codes, and they can be billed and paid within a global period without the need for a modifier.