Urology Coding Alert

Question: A patient with a penile abscess came into our office. The urologist did I&D and had the nurse draw blood for a CBC. The patient's WBC came back elevated. The physician was concerned that the patient had gangrene, so he admitted him to the hospital for IV antibiotics. The next day the urologist performed a debridement. The patient remained in the hospital for eight days and his culture did come back as gangrene. Is there a way to code this so we get paid for these services and the urologist's daily visits while the patient was in the hospital?


North Carolina Subscriber


Answer: First, you should report the incision and drainage procedure that the urologist performed in the office using 10060 (Incision and drainage of abscess [e.g., carbuncle, suppurative hidradenitis, cutaneous or subcutaneous abscess, cyst, furuncle, or paronychia]; simple or single) or 10061 (... complicated or multiple) as the medical documentation indicates. Your diagnosis code to support the I&D procedure would be 607.2 (Penile abscess).

Remember: Keep in mind that both 10060 and 10061 have a 10-day global period. The same-day initial hospital admission is therefore included in the global of the I&D surgery, and you should not report it for either Medicare or private carriers.

For the second day, report 11004 (Debridement of skin, subcutaneous tissue, muscle and fascia for necrotizing soft-tissue infection; external genitalia and perineum) for the penile debridement. Append modifier 58 (Staged or related procedure or service by the same physician during the postoperative period) since this is a more invasive secondary procedure that was performed in the global of the I&D. Code 11004 has a zero-day global. Use diagnosis code 785.4 (Gangrene).

Key: For Medicare, the additional hospital days would be considered in the global period of the I&D procedure, and you should not report those days to your Medicare carrier. But some private carriers, which may not consider these postoperative days as a normal smooth convalescence, may pay for the postoperative hospital days. Therefore, to private carriers you should report 99232 (Subsequent hospital care, per day, for the evaluation and management of a patient ...) for each of the hospital visits. Append modifier 24 (Unrelated evaluation and management service by the same physician during a postoperative period) each time to indicate that the follow-up hospital visits occurred during the post-op global period.

Tip: Also for private carriers, remember on the day of hospital discharge you should code the hospital discharge summary using 99238 (Hospital discharge day management; 30 minutes or less) with modifier 24 appended.