Urology Coding Alert

Question: Are office visits post-op kidney transplant payable with diagnosis V58.69, or do payers consider this related to the transplant and part of the global package?


Colorado Subscriber
Answer: Basically, whether you can report office visits separately depends on what condition you're using diagnosis V58.69 (Long-term [current] use of other medications, high-risk medications) for. If the "high-risk" medication you're using V58.69 to represent is immunosuppressive drug therapy, then you can report the office visit CPT code during the surgical global period and expect to be paid.

Note: All kidney transplant procedure codes have a 90-day global period. Be sure to append modifier 24 (Unrelated evaluation and management service by the same physician during a postoperative period) to the E/M code to overcome the global package guidelines.

Medicare will pay for certain services provided during the post-op global period, and one of those services is immunosuppressive drug therapy. Therefore, you could bill for that office visit with modifier 24. If your physician is giving the transplant patient immunosuppressive drug therapy and that's why the physician is seeing the patient for the office visit, when you use V58.69, report the office visit.

Tip: You may also want to look at V07.2 (Prophylactic immunotherapy) as a secondary diagnosis to see if that code is appropriate for the immunosuppressive therapy as well.

If, however, the "long-term high-risk medication" you're using V58.69 to refer to is something such as long-term antibiotic treatment, you don't likely have enough of a high risk or complication to justify reporting the E/M service separate from the procedure's global package.