Urology Coding Alert

Correct code selection for suprapubic catheter insertion is a true test of a coder's skills: Not only are they working with CCI Edits bundled codes but they must know their modifiers! The main reason for inserting a suprapubic tube, procedure codes 51010 (Aspiration of bladder; with insertion of suprapubic catheter) and 51040 (Cystostomy, cystotomy with drainage), is an obstructed urethra that makes urethral catheterization difficult or if there is anticipated retention during a surgical procedure. There are four questions you should ask yourself before deciding how to code your next suprapubic catheter insertion:

1. Is it bundled? 2. Is it not an integral part of a primary procedure or not typically performed with that procedure? 3. Is cystostomy excluded from the CPT definition of the primary procedure? 4. If performed within a global period, are there special circumstances that require the tube insertion or exchange? If you answer "yes" to any of these questions, chances are you're going to need a modifier appended to the suprapubic catheter insertion if you want to be reimbursed. Do the Trick With Modifier -58 For suprapubic catheters, modifier -58 (Staged or related procedure or service by the same physician during the postoperative period) is appropriate when a more extensive procedure is required in the global period.

For example, on day one a Medicare patient has a percutaneous insertion of a suprapubic tube for urinary retention (51010), which has a 10-day global period. Unfortunately, the tube does not drain well, so the next day the patient must have a formal open suprapubic cystostomy (51040), a procedure considered more complicated and therefore more extensive than the original procedure, 51010. This second procedure can then be coded 51040-58 to indicate a more extensive procedure and be fully reimbursed. Another circumstance that will dictate whether you should use modifier -58 is "if you know up front that you are going to be doing an additional procedure that is during the postoperative period," says Wanda Strickland, CPC, with Mid-Carolina Urology in Pinehurst, N.C. And if you are using "staged or related" as the key to determining when to use modifier -58, you have to know where to look for the documentation to support it. Look in the history and physical report for an indication that a postoperative procedure was premeditated. "If an IVP was taken or if there was documentation in the office that a patient had right and left stone and the right was going to be treated first, leaving the left stone to be treated at a later date, this constitutes a staged procedure," says Kerry Dillon, CPC, business office manager of Greenwood Urological in Greenwood, S.C.
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