Marisela Posted Tue 15th of October, 2019 15:01:10 PM
When the physician performs a TRANSRECTAL finger-guided biopsy of the prostate (55700) for elevated PSA and also performs a TURP(52601) for BPH, would modifier -XS be appropriate or would it be -79?
SuperCoder Answered Wed 16th of October, 2019 02:59:32 AM
CPT code 55700 (biopsy, prostate; needle or punch, single or multiple, any approach) cannot be reported with 52601 (transurethral electrosurgical resection of prostate, including control of postoperative bleeding, compete [vasectomy, meatotomy, cystourethroscopy, urethral calibration and/or dilation, and internal urethrotomy are included]) if the procedures are performed on the same day because a biopsy done as part of an excision is considered standard medical practice. Only if the biopsy is performed in an entirely different session and the prostate resection is done as a result of the biopsy could these two procedures be reported together. If this were the case, modifier -59 (distinct procedural service) would be appended to the biopsy code and there would have to be clear documentation present in the medical record that the biopsy was distinct and separate from the resection.
Hope this helps !