Urology Coding Alert

Question: We have a Medicare patient that a large stone. Our doctor states the term is stone burdon. The size and shape of the stone required two separate ESWLs. The first ESWL (right side) side was on March 21 and we coded it 50590 (lithotripsy, extracorporeal shock wave). The second ESWL (right side) was on May 2 and again we coded it 50590. The first procedure was paid. The second procedure was denied. I understand this denial because it fell within the 90 day global. But is there a modifier that would allow us to be paid for the second procedure? The size and shape of the stone requires two ESWLs.

Sharon Gonzales,
Albuquerque Urology Associates, Albuquerque, N.M.

Answer: In this instance modifier -58, staged or related procedure or service by the same physician during the postoperative period, should be appended to the second procedure (i.e., 50590-58) when performed during the global period of another surgery, if you had documented a plan to do the second ESWL when the first one was done. At the time of the original surgery the physician knew that a second procedure would be required to completely remove the stone fragments (i.e., it was a staged procedure). The use of this modifier will allow the claim to appropriately bypass the Medicare edit and continue on to processing and payment. In the absence of any documentation of a plan to perform a second ESWL, you should file 50590 with a modifier -78.

Answers to You Be the Coder and Reader Questions provided by: Ray Painter, MD, president, PRS, Denver, Colo.; Sandy Page, CPC, CCS-P, co-owner, Medical Practice Support Services, Denver, Colo.; Laura Siniscalchi, RHIA, CCS, CCS-P, CPC, Education Coordinator for Coding, Beth Israel Deaconness Medical Center, Boston, Mass.; Catherine Brink, CMM, CPC, president, Healthcare Resource Management Inc., Spring Lake, N.J.