Medical Billing Forum

General Category => New! => : Dianac August 29, 2012, 07:20:12 PM

: Medicare Denial for 2nd TURP - 368 days apart
: Dianac August 29, 2012, 07:20:12 PM
Hi. This is the first time I have asked a question here, but this one has me puzzled and I have about 1 week before this claim is a year old.
Our patient had a TURP (52601) done 8/6/10 dx 185 and another on 9/9/11 same code and dx. Medicare continually denies this 2nd TURP saying the patient is responsible. I have tried modifiers 78 and 58 as well without success. Any ideas? Medicare will not give hints.
Thanks.
Diana.

p.s. thanks..sometimes simple is complicated
: Re: Medicare Denial for 2nd TURP - 368 days apart
: supertaz93 August 30, 2012, 09:54:30 AM
From what I see, 52601 is a once in a lifetime procedure and you will need to use a different code.  http://codingnews.inhealthcare.com/specialty-coding/urology-coding-turp-urodynamics-and-stone-removal/
: Re: Medicare Denial for 2nd TURP - 368 days apart
: Dianac September 03, 2012, 03:19:31 AM
Thank You!! I believe this is what I needed.