TURP for bleeding

katysuegood@gmail.comkatysuegood@gmail.com
in Clinical & Coding
Hi all,

I have received notification about a denial we received related to an inpatient TURP. Medicare is stating they will not pay for procedure 0V508ZZ because we do not have a C61 code (prostate cancer). This patient did not have cancer. The current Pdx is N40.1m enlarged prostate with lower urinary tract symptoms. However, this was not simple BPH. This patient was admitted with significant hematuria. They did a cystoscopy with irrigation to stop bleeding but he later re-bled requiring numerous blood transfusions. At that point they decided to cauterize the prostate to stop bleeding. The procedure code appears to be correct to me? as for the CM codes, the coder only has the BPH and hematuria, not the actual bleeding prostate coded. Should it be? And should it be Pdx? I am not sure if Medicare will accept it if it was but it seems this would more appropriately capture the situation?

Any thoughts, suggestions, or guidance would be greatly appreciated.

Thanks!

Katy Good, RN, BSN, CCDS, CCS
Clinical Documentation Program Coordinator
Flagstaff Medical Center
Kathryn.Good@nahealth.com
Cell: 928.814.9404

Comments

  • katysuegood@gmail.comkatysuegood@gmail.com
    edited May 2016
    Just heard from billing that Medicare with ONLY pay for this procedure if we have the C61 code, which is not appropriate in this case. I am fairly confident the procedure code is correct. Right?
    A 26 continuous flow resectoscope was inserted with obturator after timeout was confirmed. The lens was inserted with plasma button. Large amount of clot was again noted within the bladder. Catheter-tipped syringe was used for manual irrigation to remove all clots. Scope was reinserted and bladder was again thoroughly and systematically inspected. No lesions noted consistent with transitional cell carcinoma. Large occlusive prostate with a large vesicle component especially at the left side was noted. Plasma button was used to initially cauterize large aspects of the prostate especially the intravesical portion. Large median lobe made visualization difficult and the plasma button was used to vaporize large median lobe. Cauterization was then resumed especially to the left aspect over the much larger, friable aspect was noted. At the termination with no flow through the scope there was no active bleeding to be noted in any area with a thorough and systematic inspection.

    Thanks!

    Katy Good, RN, BSN, CCDS, CCS
    Clinical Documentation Program Coordinator
    Flagstaff Medical Center
    Kathryn.Good@nahealth.com
    Cell: 928.814.9404


  • martin.conroymartin.conroy
    edited May 2016
    Are you sure about the px. Code 0V508ZZ. Approach=open?


  • ssalinasssalinas
    edited May 2016
    The bleeding was controlled by cauterization which codes to destruction. (Vaporization of prostate codes to the same.) Destruction of Prostate via natural or artificial opening, endoscopic (0V508ZZ) is correct as far as I can see.

    Sharon Salinas, CCS
    Health Information Management
    Barlow Respiratory Hospital
    2000 Stadium Way, Los Angeles CA 90026
    Tel: 213-250-4200 ext 3336
    FAX: 213-202-6490
    ssalinas@barlow2000.org


  • katysuegood@gmail.comkatysuegood@gmail.com
    edited May 2016
    Thanks Sharon. It seems so strange to me that Medicare won't pay for this. He clearly needed admission for this procedure because of his anemia and need for transfusions.

    I guess this is why I don't work on the UR side of things.... ;-)

    Katy Good, RN, BSN, CCDS, CCS
    Clinical Documentation Program Coordinator
    Flagstaff Medical Center
    Kathryn.Good@nahealth.com
    Cell: 928.814.9404


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