Urology Coding Alert

Question: A patient undergoes a radical prostatectomy. Sixteen days after the removal of his foley catheter, the patient presents in the office with complaints of a slow urinary stream and difficulty voiding. Unable to pass a catheter into the bladder due to an obstruction deep within the urethra, the urologist performed a cystourethroscopy (52000) that revealed a stricture, and a punch trocar cystostomy (51010, Aspiration of bladder; with insertion of suprapubic catheter) was performed. The urologist plans an incision of the stricture (52276, Cystourethroscopy with direct vision internal urethrotomy) to be performed in the hospital. Because the patient is within a 90-day global, do I need to add modifier -78 to all three procedures? Should I consider this obstruction/stricture a complication from surgery?
     
Louisiana Subscriber Answer: The office surgery you did certainly was for a complication following the radical prostatectomy. If this patient has Medicare, you would only be able to charge for these procedures if the surgery was performed in the OR at the hospital. When performed in the hospital operating room, append modifier -78 (Return to the operating room for a related procedure during the postoperative period) to the surgical codes as you indicated, because these procedures were performed for complications in the global of the prostatectomy. Medicare will not reimburse if these services are performed in the office.
 
For a private carrier following a CPT surgical package, when you perform these procedures in your office, append modifier -79 (Unrelated procedure or service by the same physician during the postoperative period) to the surgical codes. Many private carriers will not view these problems as complications but as new problems and will reimburse for surgical treatments of postoperative complications even when performed in the office during a global period.