UCR 088: Clarification -TC and -26 modifiers [#87]; FAQs - VUDS, Anterior Exenteration, and Prophylactic Antibiotic Injections

March 18, 2022

Mark, Ray, and Scott discuss comments and questions from PRS Forums: PRS Community and Urology Coding and Reimbursement Group:

1)  Re: Podcast Episode(3/11/22): -TC and -26 modifiers - Urodynamics billing: split or global?

If the UDS tests are done on Monday and the ordering doc isn’t in the clinic, but there is a supervising doc, I know we would bill for the TC under the supervising doc.

If the ordering/interpreting doc doesn’t even see the tests until 2 days later, you’re saying in today’s podcast that we bill the global service with Wednesday’s date and not Monday’s date??

OR because of the MLN article SE17023 Revised 2/1/2019, we can chose which date to use, that we could bill the global charges with Monday’s date and the interpreting docs name…..even though he wasn’t in the clinic on Monday?

I think we should bill everything under the interpreting doc on the date the service was rendered, even if he isn’t in house, based on the 2019 MLN, and not on the date he interprets it.

2)  I am asking for more info and cpt help on VUDS

3) Anterior exenteration question.

I have several different opinions about how to code this surgery. My two urologists operated together. The bladder was removed, the uterus, vagina, tubes and ovaries, pelvic lymph nodes, and ileal conduit created. so we start with 51597 with the wording for pelvic exenteration (my surgeons don't feel we qualify because we didn't remove the colon). The AUA recommendation I received was to use the 51597 with 50820. not sure i agree with that. the CPT book in its description says and/or abdominoperineal resection of rectum and colon and colostomy, or any combination thereof.
I guess im not sure what the and/or means. Is the colectomy part necessary to perform the 51597? My doctors think we should piecemeal the coding which im not a fan of.  Appreciate some advice here. Hoping there is some clarification from experts!!

4) I have started coding for a group of Urologists that bill for their prophylactic antibiotic injections separately from the procedure performed in the office.

For example: the patient comes in for a planned cystoscopy w/ Botox injection. The codes that the provider wants billed are the botox codes 52287 and J0585 and the injection of antibiotics 96372 and J0696. They will also bill them with cysto's , prostate biopsies, and other minor office procedures. I thought that I understood that prophylactic antibiotics were inherent to the office procedure, but my providers are adamant that they can be reported separately. I've tried it their way and I'm getting denials all over the place. Could you help me with this? Are my providers wrong, or my payers? Thank you!!!  


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