Nancy Posted Tue 25th of May, 2010 14:31:45 PM
A patient had a TURP over 4 weeks ago. He returned to the office passing alot of blood. A Foley catheter was placed. He started having this blood in the urine coming out around the catheter.He went to the ED where he was admitted and was started with continuous bladder irrigation. His insurance is denying this as inclusive to the TURP. Do you feel this is correct? I am new coding for Urology. Thanks for your help.
SuperCoder Answered Wed 26th of May, 2010 06:04:23 AM
Since, the TURP procedure has 90 days global so due to this, the insurance is denying the handling of post-op complications. So in this scenario you have the option to use a 78 modifier with this procedure/service (51700).
Nancy Posted Wed 26th of May, 2010 12:18:07 PM
Thank You for your answer, but I have other questions. If the Foley cath was placed in the office on 03/04/10 do we add a 78 modifier to this? The patient then on 03/05/10 went to the ED and was admitted where the irrigation was done. Can the doctor bill for the admit and the irrigation? I am sorry I am asking so many questions, but I want to be correct in my understanding.
SuperCoder Answered Wed 26th of May, 2010 14:01:55 PM
Since, the patient had the foley catheter inserted on 03/04/10 so you can code 51702 with 78 and 51700/78 on 03/05/10. Now! if the patient has Medicare or any other payer that follows Medicare’s policies then the procedure and the admission is considered as global.
The AMA states in the preamble to the surgery section to CPT that the global does not include care for postoperative complications and that this care for complications and exacerbations should be separately coded and billed. So, if the patient does not have Medicare or a payer that follows Medicare’s rules, you can code and bill the ER E/M services. They would be coded as 9921x-24.
Append modifier 24 (Unrelated evaluation and management service by the same physician during a postoperative period) and link to the diagnosis for the postoperative bleed.
SuperCoder Answered Wed 26th of May, 2010 14:29:02 PM
Thank you for your patience. Please find the below response for your query.
Per the Medicare Claims Processing Manual, Chapter 14, Section 40.5, “When the ASC performs multiple surgical procedures in the same operative session that are subject to the multiple procedure discount, contractors pay 100 percent of the highest paying surgical procedure on the claim, plus 50 percent of the applicable payment rate(s) for the other ASC covered surgical procedures subject to the multiple procedure discount that are furnished in the same session.”
Depending on your documentation and which other codes you are billing in addition to 92928, you may determine which code will take the 50% reduction in reimbursement. Keep in mind, depending on which LHC code is involved, there may be an outpatient Medicare NCCI edit bundling the LHC code into 92928. Code 93458 is bundled into 92928, but you can override the edit with a modifier when clinical circumstances and documentation support doing so. There is no 92928/93452 edit, but you still need to be sure that your coding reflects the spirit of the coding guidelines.
Kindly check with your payer for any specific reimbursement guidelines for this type of procedures.
Hope this Helps!