Urology Coding and Reimbursement Podcast

UCR 20: FAQs - Question about D40.0, Neoplasm uncertain behavior of prostate? Modifier -57 v Modifier -25?

01 Sep 2020

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Mark, Ray and Scott answer 3 questions from the Urology Coding and Reimbursement GroupScenario:New patient being seen via telemedicine for the first visit. Dr. has ER reports and a CT with finding of "a nodular mass-like extension from the left posterior aspect of the prostate into the seminal vesicle and an impression of "Probable prostate cancer extending into the left seminal vesicle". A PSA was done and came back at 950.0 ng/mL. At the time of the Trusp/Bx, Dr coded D40.0, Neoplasm uncertain behavior of prostate. The physical findings at the biopsy were "Large, nodular hypoecoic mass left base & mid-gland of prostate". I think Dr. was trying to show that he didn't have pathology to prove malignant neoplasm and since there isn't an "Unspecified neoplasm" for prostate, I think he should just code what he knows for sure.....nodular prostate and elevated PSA......possibly also use N42.9 Disorder of prostate, unspecified which means anything from an abnormal prostate on exam to cancer. Could N42.9 be used as the "neoplasm of prostate, unspecified behavior"??Hi, dr did a laparoscopic radical nephroureterectomy for ureteral cancinoma and also a repair of a lumbar herniai came up with 50548 for the nephroureterectomy but am unsure of the hernia thanksCan you clear up when to use modifier -57 and modifier -25?Is -57 for clinic AND hospital consults? Does the surgery you are planning for the same day have to be a surgery with 90d global? what if it's just ureteroscopy? Does putting in a catheter after an ER consult need a -57 modifier?Is -25 used for separate E/M ONLY if they have a separate procedure? (for instance come in for cysto but then mention a genital wart that is then removed) Or can you add -25 for a totally unrelated problem that requires medicine or counseling but no procedure (for instance come in for cysto and then mention ED and discuss options/prescribe viagra)

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13:00H | 21 DIC 2025 | Fin de Semana

01 Jan 1970

Fin de Semana

10:00H | 21 DIC 2025 | Fin de Semana

01 Jan 1970

Fin de Semana

12:00H | 20 DIC 2025 | Fin de Semana

01 Jan 1970

Fin de Semana

2ª PARTE | 06 ENE 2026 | EL PARTIDAZO DE COPE

01 Jan 1970

El Partidazo de COPE

3ª PARTE | 22 ENE 2026 | EL PARTIDAZO DE COPE

01 Jan 1970

El Partidazo de COPE

3ª PARTE | 04 MAR 2026 | EL PARTIDAZO DE COPE

01 Jan 1970

El Partidazo de COPE

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Urology Coding and Reimbursement Podcast

UCR 20: FAQs - Question about D40.0, Neoplasm uncertain behavior of prostate? Modifier -57 v Modifier -25?

This episode hasn't been transcribed yet

Other recent transcribed episodes

13:00H | 21 DIC 2025 | Fin de Semana

10:00H | 21 DIC 2025 | Fin de Semana

12:00H | 20 DIC 2025 | Fin de Semana

2ª PARTE | 06 ENE 2026 | EL PARTIDAZO DE COPE

3ª PARTE | 22 ENE 2026 | EL PARTIDAZO DE COPE

3ª PARTE | 04 MAR 2026 | EL PARTIDAZO DE COPE

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