Intra-operative consult must meet specific criteria to code

September 1, 2007

While there is no specific code for an intra-operative consult, one can bill a consultation code if the criteria are met.









A While there is no specific code for an intra-operative consult, one can bill a consultation code if the criteria are met. Either the inpatient or outpatient consultation codes can be used, depending on patient status at the time of the operation. Remember that a consultation requires the following:

Q Is there a CPT code for checking an expressed prostatic secretion under the microscope on an office visit?

Q What is the correct coding for a facility treating a patient with extracorporeal shockwave lithotripsy and cystourethroscopy? I don't believe it should be 52353 because the lithotripsy it refers to is not shockwave lithotripsy. I believe it should be 50590 plus the appropriate cysto code.

A The correct code for ESWL is 50590. The cystourethroscopy code 52000 as well as the cysto with retrograde code 52005 are considered to be included in the 50590 and can only be billed if done for a purpose other than preparation for ESWL. A modifier –59 is needed on either cysto code if it is appropriate to report.

In the instance where a cysto with retrograde (52005) is performed as a diagnostic service that leads to the diagnosis and then immediate treatment of the stone with ESWL, the modifier –58 should be appended to the 52005 instead of modifier –59.

Q Would you apply modifier –52 to code 54162 if done in the office under local anesthesia?

A No. It is not necessary to add a modifier to 54162 (lysis or excision of penile post-circumcision adhesions) if performed in the office. The –52 modifier is a reduced service modifier. However, as you can see by reading the definition-"Lysis or excision of penile post-circumcision adhesions"-place of service is not restricted for this service.

Although you may have been accustomed to performing the procedure in the hospital under a general anesthetic, there would be no penalties and no modifiers required for performing it in the office under a local. Bill it without a modifier and collect your non-facility fee.

Unfortunately, the local anesthetic is included in the procedure and that cannot be charged separately.

Urologist Ray Painter, MD, is president of Physician Reimbursement Systems, Inc., in Denver and is also publisher of Urology Coding and Reimbursement Sourcebook. Mark Painter is CEO of PRS Urology SC in Denver.

Disclaimer: The information in this column is designed to be authoritative, and every effort has been made to ensure its accuracy at the time it was written. However, readers are encouraged to check with their individual carrier or private payers for updates and to confirm that this information conforms to their specific rules.