Urology Coding Alert

Question: We are getting denials for urodynamics testing in the postoperative period of surgeries. Are these tests really part of the surgical package, or are we doing something wrong in how we submit them? UCA Subscriber Answer: Urodynamics tests performed after major and minor procedures should definitely be paid but only if you know how to correctly apply modifiers -58, -78 and -79. It is not surprising that you are facing denials for postoperative uroflow studies because while urodynamics testing is diagnostic, the urodynamics codes are in the surgery section of CPT, not the medicine section, and are often confused as procedures included in the surgical package. To provide reimbursement, Medicare and most private payers require you to append modifiers to the urodynamics code(s). For example, if you perform a uroflow test for a Medicare patient after a prostatectomy, 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]), you should append one of the following modifiers depending on your carrier's preference: -58 (Staged or related procedure or service by the same physician during the postoperative period), -78 (Return to the operating room for a related procedure during the postoperative period) or -79 (Unrelated procedure or service by the same physician during the postoperative period). Check with your local Medicare carrier because you will most likely be required to append one of the surgery modifiers -58, -78, -79 for the urodynamics service to be paid. Answers to You Be the Coder and Reader Questions contributed by Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology, State University of New York, Stony Brook; and Morgan Hause, CCS, CCS-P, privacy and compliance officer for Urology of Indiana LLC, a 19-urologist practice in Indianapolis.