The answer hinges on the urologist’s interpretation.
Question: A patient had a robotic prostatectomy for prostate cancer on Jan. 1. Then the patient started experiencing voiding problems in February. At that time my doctor did a cystoscopy to check for bladder neck contracture, which he didn’t find. Is this a new problem? How should I code the second procedure?
Virginia Subscriber
Answer: You’ll have to discuss the procedure with your urologist to see if he considers the voiding dysfunction to be a new problem or a complication of the radical surgery.
Option 1: If the voiding trouble is a new problem, you should report the cystoscopy within the global of the radical prostatectomy using modifier 79 (Unrelated procedure or service by the same physician during the postoperative period). So you will report 52000-79 (Cystourethroscopy [separate procedure]) for both Medicare and commercial payers. The diagnostic code should represent the symptom(s) that led to the cystoscopic examination.
Option 2: If your urologist feels that the problem with voiding is a complication of the surgery, your coding will depend on the payer and the location where the cystoscopic examination took place.
If the patient has Medicare coverage and your urologist performed the cystoscopy in the hospital operating room, then bill the cystoscopy with modifier 78 (Unplanned return to the operating/procedure room by the same physician following initial procedure for a related procedure during the postoperative period). If this Medicare patient underwent the cystoscopic examination in the office, most Medicare carriers would not reimburse for this procedure.
For private payers, bill for an in-office cystoscopy with modifier 79 as mentioned above, even if you feel this is a complication. Most commercial and private payers will reimburse for the procedure performed in the global of the radical prostatectomy, and will pay (no matter the location) for any problems after surgery that prevent a smooth uncomplicated surgical convalescence and postoperative care.
Are you a urology coding expert? Attend Dr. Ferragamo’s Capture the Most Challenging Payments for Urology Services audio conference.
Be a hero. Join Supercoder.com and be a part of the coding community at the Supercoder.com Facebook Fan Page.