Urology challenge: Keep in mind all the factors for Post-Op Procedure Coding

Urology challenge: Keep in mind all the factors for Post-Op Procedure Coding

The answer depends on the urologist's interpretation.

Problem: A patient went through a robotic prostatectomy for prostate cancer on Jan. 1. After that the patient started experiencing voiding problems in February. At that time my physician performed a cystoscopy to check for bladder neck contracture, which he didn't find. Is this a new problem? How should I report the second procedure? Virginia Subscriber

Solution: You should discuss the procedure with your urologist to check if he considers the voiding dysfunction to be a new problem or a complication of the radical surgery.

Alternative 1: If the voiding trouble is a new problem, then 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). Therefore, you will report 52000-79 (Cystourethroscopy [separate procedure]) for both Medicare and commercial payers. The diagnostic code must represent the symptom(s) that led to the cystoscopic examination.

Alternative 2: If your urologist feels that it is a complication of the radical 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 carried out 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). Most Medicare carriers would not reimburse for the procedure if this Medicare patient underwent the cystoscopic examination in the office.

For private payers, bill 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 carried out 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.

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