UCR 209: FAQ -Designated procedure room, -78; stopping a procedure prior to entering OR; and is a stent included in a pyeloplasty?

August 30, 2024 

Mark, Scott, and Ray talk about questions that came into the PRS Communities.

1. Hi, I have a coding question pls. Thanks so much.

    Our urologist performed HIFU a month ago. Pt. had come back for Dysuria postop complication, has been having dysuria for 2 weeks. Our urologist decided to perform Cystoscopy for this.

    Cystoscopy performed, but we did Not bring Pt. back to OR. So, it should Not be a billable service
   But then, Per NCCI, Diagnostic test and procedures may be paid as a separate service during global.

   Should we bill CPT 52000? and If so, will modifier be -58, since it did not occur in OR so -78 would not be an appropriate modifier?

    Please suggest, thank you!

2. Modifier 73 Question: Can this modifier be used when the patient is in the pre op area and he/she was given Dilaudid and another mediation and then prepped for surgery but then the patient decided they did not want to proceed because the pain medication made them feel better(Patient had a Kidney Stone). It seems resources were used and a block of time was scheduled for the facility. Wording can be a little different from our MAC, CPT, etc when some state the patient has to be taken to the operating room. Thanks for your time.

3.  Hi, We are getting some pushback and would like to know when/if ureteral stents are billable intraoperatively. Our providers are placing a stent, performing pyeloplasty in the same ureter, and the stent is routinely removed one week later.
   Is this stent placement an inherent part of performing the primary procedure, or is this a billable service? Thank you!