Length of hospital stay determines 'usual time'

November 1, 2006
Mark Painter

Mark Painter is CEO of PRS Urology SC in Denver.

Ray Painter, MD

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

What is considered the usual postoperative bleeding time following a transurethral resection of the prostate?

A A definition of normal postoperative bleeding time is not published. If one were to follow the definition of the global period as the normal postoperative bleeding time, then a different CPT code would have to be chosen for the treatment of postoperative bleeding during the 90 day postoperative global or the TURP. The best available code for treatment of bleeding, other than code 52606, is 52214.

A second option would be to treat "normal postoperative bleeding time" as the average time for hospitalization following a TURP. This definition makes more sense clinically. Therefore, code 52606 would be used for treatment of postoperative bleeding that occurs after discharge, and bleeding during the hospital stay should be coded as 52214. As mentioned above, the global period of the 52601 is 90 days. Therefore, payment within the global period would require a modifier –78 for treatment of a complication in the operating room during the global period. The –78 could be appended to the code 52606. The –78 could also be appended to code 52214 for the fulguration of bleeding in the area.

A The type of scope (flexible or rigid) does not affect the choice of CPT code for these services. The correct CPT code for reporting this service would be 52353: cystoureteroscopy, with ureteroscopy and or pyeloscopy; with lithotripsy (ureteral catheterization is included). If the double-J stent is left indwelling, the code is 52332-59.

Q What is the proper code for a flexible nephroscopy with electrohydraulic lithotripsy and insertion of double-J catheter?

A The appropriate code for a percutan-eous nephroscopy/pyeloscopy with lithotripsy would be 50581. However, if the procedure (a pyeloscopy with lithotripsy) was performed through a ureteroscope, then you would code it exactly as answered in the previous question.

Q Our docs performed a right ureteral stent placement with surgical repair of the lower third right ureter during a surgery for ileostomy. When the stent was placed in the ureter, they came in through the kidney first, then the ureter, and finally the bladder. They went backwards. Do I code the same as if they went the other way?

A Coding for the placement of a stent in this fashion would be most closely reflected by the coding of an antegrade stent placement. Per the description above, it sounds as if a catheter was inserted and an endoscope was used. If this is the case, use code 50572, renal endoscopy through nephrotomy or pyelotomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with ureteral catheterization, with or without dilation of ureter. A –52 or –22 could be added to slightly modify the description if desired.

If, in fact, a stent was placed in the ureter through an open incision without the use of the endoscope, then code 50605, ureterotomy for insertion of indwelling stent, all types, might best describe the service provided.

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