Urology Coding Alert

Question: I'm trying to determine how to code the following scenario: A patient is in the global period following an open suprapubic cystostomy (51040) and returns to our office two weeks later for an SP tube change. I'm unable to use modifier 78 (Return to the operating room ...) because the tube change took place in the office rather than the operating room. Can I bill for the SP tube change?


Texas Subscriber


Answer: When your urologist changes a suprapubic (SP) tube within the global period of a cystostomy, Medicare and private payers may consider the surgery as part of the original procedure. In this case, the SP tube change occurs within the 90-day global period of an open cystostomy that you reported using CPT 51040 (Cystostomy, cystotomy with drainage).

Report either 51705 (Change of cystostomy tube; simple) or 51710 (... complicated) with modifier 58 (Staged or related procedure or service by the same physician during the postoperative period) for an SP tube change that takes place in the office during the global period of the surgery.

Good idea: You may want to suggest that, in situations like this, your doctor include a note in his operative report stating that, as part of the surgical procedure, he may perform a tube change during the global period.