Urology Coding Alert

Question: A patient had an open sigmoid resection. The general surgeons did the resection. My urologist placed the preoperative catheters. The report then indicates that after the colon was mobilized, the urologist did a distention of the bladder with sterile water to check for any leakage. How do I report my urologist's work on this case? Could the urologist be considered a co-surgeon for the colon resection?

Connecticut Subscriber

Answer: You should report 52005 (Cystourethroscopy, with ureteral catheterization, with or without irrigation, instillation, or ureteropyelography, exclusive of radiological service) for the insertion of the preoperative ureteral catheters. Append modifier 50 (Bilateral procedure) since he placed them in each ureter.

The filling of the bladder -- 51700 (Bladder irrigation, simple, lavage and/or instillation) -- is bundled into the 52005 and cannot be unbundled.

Dx help: For the catheter placements use a diagnosis such as 591 (Hydronephrosis) if that condition does exist. Alternatively, use the diagnosis the surgeon uses for his procedure. You could also report 591 and V07.8 (Other specified prophylactic or treatment measure) indicating the catheters were place prophylactically to avoid hydronephrosis.

Pointer: Your urologist did not work as a co-surgeon to the general surgeon. When two surgeons work together to perform distinct portions of a complex procedure which CPT identifies with a single reportable code, you will need to add modifier 62 (Two surgeons). In this case, the physicians did not perform portions of the same procedure, so modifier 62 does not apply.