Urology Coding Alert

Hint:  The global period and point of service make a difference

Editor's note: This article is the third in a three-part series on correct modifier use. When your urologist performs a surgical procedure, you may have a hard time deciding what, if any, modifiers you should apply. Read on to learn the specifics of how to report your urologist's surgical work for post-op complications, how to get paid for unrelated surgical procedures, and what to submit when your physician acts only as an assistant surgeon. Don't Use Modifier 78 Without an Operating Room If your urologist performs a procedure and then the patient returns to the operating room with complications, you need to look at modifier 78 (Return to the operating  room for a related procedure during the postoperative period). You'll typically use this modifier when there is a complication after a procedure, such as bleeding from the surgical site, says Laureen Jandroep, OTR, CPC, CCS-P, CPC-H, CCS, a leading national authority on medical coding and reimbursement.

Take note: The follow-up procedure must be serious enough that your urologist performed it in the operating room, or you can't use modifier 78. "There must be an operating room involved in order to even consider this code, and it has to be for a related procedure," Jandroep says.
 
Example: A patient undergoes a transurethral resection of an enlarged prostate gland (TURP). Four days following the surgery, the patient experiences heavy bleeding and hematuria, and returns to the operating room for surgery to control the bleeding. This represents a complication that required a return to the OR for treatment within the global period of the initial procedure.

In this scenario, you would report CPT 52214 (Cystourethroscopy, with fulguration [including cryosurgery or laser surgery] of trigone, bladder neck, prostatic fossa, urethra, or periurethral glands). Append modifier 78 to 52214 to indicate that your physician performed surgery in the operating room due to complications after a prior procedure.

Tip: Modifier 78 does not reset the global surgical period, says Catherine Brink, CMM, CPC, president of HealthCare Resource Management Inc. in Spring Lake, N.J. In the example above, the global period of the initial surgery, the TURP, would still be in effect.

What to expect: When you append modifier 78, Medicare will only pay the physician the work RVU for the second procedure. This isn't the case with most other payers Apply 79 to New Circumstances You should apply modifier 79 (Unrelated procedure or service by the same physician during the postoperative period) when:

• your urologist must undertake the subsequent surgery for conditions unrelated to an initial surgery, and

• the subsequent surgery occurs during the global period of the initial surgery. In other words, Jandroep says, if the same physician [...]