Urology Coding Alert

Extra time evacuating clots should mean full pay - despite NCCI bundles TURP complications can mean complications on the coder's desk, as one urology coder in Ohio discovered. The key to full and ethical reimbursement is in knowing when you're justified in breaking NCCI Edits bundles.

No matter how many coding guides, supplements and resources you collect, there's always a coding dilemma that just won't fit neatly into the scenarios described in CPT Codes or presented in the coding seminar just attended. See how our experts approach this one-of-a-kind coding conundrum and apply these concepts to your difficult cases.

The scenario: The urologist performed a 30-minute subsequent hospital visit, and then on the same day took the patient to surgery. He started out by doing a cystourethroscopy and a fulguration of bleeders and evacuating several obstructing clots. The urologist found that the prostatic fossa was bleeding from diffuse varicosities. He fulgurated those but was still unable to stop the bleeding. He then placed a Foley balloon catheter with various degrees of traction but still could not stop the bleeding.

The urologist consulted with the patient's family. The family agreed to go ahead with a transurethral resection of the prostate (TURP).

Upon completion of the bladder neck resection, the patient's urine was at first relatively clear, but the bleeding soon became heavier. Various degrees of traction and different amounts of water in the balloon were once again unable to stop the bleeding. The urologist replaced the scope but could see no discrete area of bleeding.

The urologist spoke with the family about an open procedure. He then performed a cystotomy with Bovie cautery of the prostaic fossa and evacuated the clots. The prostatic urethra appeared diffusely hemorrhagic. The urologist also placed hemostatic stitches within the prostatic fossa and packed the fossa. He then placed a Malecot catheter for suprapubic drainage, secured the tube with a Vicryl suture, and closed the cystotomy. He brought out the Malecot catheter through a separate stab incision in the fascia and skin and drained the space of Retzius. Finally, he closed the fascia and skin incision and sutured the suprapubic tube and drain in place. Code TURP, Evacuation, Fulguration Separately Coding solution: Your first step when tackling this challenging coding scenario is to code the subsequent hospital visit, says Sheila Gonzagowski, CPC, coder for Metro Urology in St. Paul, Minn. If the urologist decided during his examination of the patient to perform surgery on that day, append modifier -57 (Decision for surgery) to the E/M code for the subsequent hospital visit (99232, Subsequent hospital care, per day, for the [...]