Urology Coding Alert

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


Question: Can you bill for urinary retention after prostate seed implantation during the global period? I say put a modifier -79 on the catheterization or a -24 on the evaluation and management visit. Does an intraoperative consult automatically become a level four or five (i.e., to find a ureter for a general surgeon)?

-Florida Subscriber

  Answer: Per CPT guidelines, postoperative urinary retention would be reported separately because it could not be considered normal uncomplicated follow-up care. Modifiers -24 (unrelated E/M service by the same physician during a postoperative period) and -79 (unrelated procedure or service by the same physician during the postoperative period) would be correct.

There are some payers, however, who would consider the retention a complication of the procedure and not allow payment for services provided in the physicians office. Check with the payer for specific guidelines. Most payers should consider office services for post-op retention exempt from the global period of the surgery because the retention was not due to a problem with the surgical technique. Medicare and private payers have been known to deny the services even with correct modifier usage, so you may have to appeal.