Urology Coding Alert

Don't let similarities with other modifiers foil your coding

Editor's note: This article is the second in a three-part series on correct modifier use. Stay tuned to next month's issue for helpful tips about modifiers 78, 79 and 80. When your urologist performs a staged procedure, provides an E/M service within the global period, or participates in a surgery with another physician, knowing which modifier to append to capture full payment can be a headache. Read on to learn the in's and out's of modifiers 24, 58 and 62 and how you can avoid a modifier mixup.

"Understanding modifiers becomes increasingly more important every year," says Chandra Hines, business office manager for NC Urological Associates Inc. in Raleigh, N.C. "It is the way in which physicians can complete the sentence to insurance companies. It is the way to explain the various circumstances of procedures and services. Modifiers explain the particular circumstance surrounding that particular patient."

1. Avoid E/M Denials During Post-op Periods With 24 You can attach modifier 24 (Unrelated evaluation and management service by the same physician during a postoperative period) only to an E/M code. Your physician must perform the service during the global surgical period for modifier 24 to be appropriate.

You should append modifier 24 when your urologist performs an unrelated E/M service during the postoperative period of a minor or major surgical procedure. Without this modifier, your payer will most likely deny any E/M services you report during a postoperative period. By attaching modifier 24, you are indicating to the carrier that a separate, unrelated service occurred before the end of the global surgical period.

"If we append 24, we are telling the payer we have proof on file that this is a different reason that this physician is seeing the patient within the follow-up period," says Laureen Jandroep, OTR, CPC, CCS-P, CPC-H, CCS, a leading national authority on medical coding and reimbursement.
 
How it applies to you: Your urologist performs a transurethral electrosurgical resection of prostate (TURP, 52601, Transurethral electrosurgical resection of prostate, including control of postoperative bleeding, complete [vasectomy, meatotomy, cystourethroscopy, urethral calibration and/or dilation, and internal urethrotomy are included]). While the patient is still within the 90-day global period of the surgery, he presents to your office for evaluation of a renal stone. You should report an established patient visit based on the level of service your physician applies using 99211-99215. Append modifier 24 to the E/M code to indicate that this office visit was unrelated to the TURP procedure. 2. Use Modifier 58 to Indicate Staged Procedure When a patient returns to the operating room within the global period of a surgical procedure, you should consider modifier 58 (Staged or related procedure or service by the same [...]