toria11
Guru
Can these be billed on the same DOS? I know you can report 52214 with a modifier 78 when it's within the post op period for 52630 but what about when they're done at the same session? Please see note below! Would modifier 59 be appropriate? Thanks!!
PROCEDURE PERFORMED: Prostate fulguration and repeat TURP.
The patient was taken to the operating room and positively identified as
well as the site of surgery during a time-out. After adequate general anesthesia, he was transferred into
the modified dorsal lithotomy position and prepped and draped in the usual sterile fashion for cystoscopy.
The 26-French continuous flow resectoscope sheath was passed with the obturator in place. The
traditional electrosurgical loop was then used to fulgurate prominent blood vessels at the bladder neck and
throughout the prostatic fossa. There was moderate amount of bullous edema on the left side of the
prostatic urethra at the bladder neck pain and apex, which was suspicious for inflammation from the right
lateral lobe. Therefore, the right lateral lobe was partially resected and thoroughly fulgurated. All prostate
chips were removed with the resectoscope loop. At the end of the resection, the prostatic fossa was
widely patent and hemostatic. The ureteral orifices were free from the region of resection, which was just
limited to the right lateral lobe. Then, the bladder was filled and drained in multiple times in order to dilate
for blood vessels at the bladder neck. Final inspection failed to reveal any obvious remaining prominent
blood vessels. The bladder had high volume with the multiple cellules and saccules and potentially some
small prostate chips. There could have been remaining but none were identified. The bladder was left full
and the scope was removed. A 22-French and 30 cc Foley catheter was inserted over the catheter guide.
The balloon was inflated to 35 cc and placed on gauze traction. The catheter was irrigated freely and
effluent came back crystal clear. He tolerated the procedure well without complications.
PROCEDURE PERFORMED: Prostate fulguration and repeat TURP.
The patient was taken to the operating room and positively identified as
well as the site of surgery during a time-out. After adequate general anesthesia, he was transferred into
the modified dorsal lithotomy position and prepped and draped in the usual sterile fashion for cystoscopy.
The 26-French continuous flow resectoscope sheath was passed with the obturator in place. The
traditional electrosurgical loop was then used to fulgurate prominent blood vessels at the bladder neck and
throughout the prostatic fossa. There was moderate amount of bullous edema on the left side of the
prostatic urethra at the bladder neck pain and apex, which was suspicious for inflammation from the right
lateral lobe. Therefore, the right lateral lobe was partially resected and thoroughly fulgurated. All prostate
chips were removed with the resectoscope loop. At the end of the resection, the prostatic fossa was
widely patent and hemostatic. The ureteral orifices were free from the region of resection, which was just
limited to the right lateral lobe. Then, the bladder was filled and drained in multiple times in order to dilate
for blood vessels at the bladder neck. Final inspection failed to reveal any obvious remaining prominent
blood vessels. The bladder had high volume with the multiple cellules and saccules and potentially some
small prostate chips. There could have been remaining but none were identified. The bladder was left full
and the scope was removed. A 22-French and 30 cc Foley catheter was inserted over the catheter guide.
The balloon was inflated to 35 cc and placed on gauze traction. The catheter was irrigated freely and
effluent came back crystal clear. He tolerated the procedure well without complications.