Timely billing, usage of apt CPT codes, ICD-10 codes and modifiers, fewer denials/rejections strengthen the financial branch of any medical practice, and the same holds true for urology. For the New Year to start on a good note, it is imperative that urology coders are well aware of the latest changes in urology billing and coding rules and guidelines.
In the case of urology medical billing and coding, beginning Oct. 1, 2016, Medicare has set the requirements of accepting only those bills where coders will use definitive diagnosis codes rather than unspecified or family codes. As Medicare has not done away with Local Coverage Decision (process or program), it will publish the changes before they implement new processes in LCD. It is also recommended that documentation of all procedures is absolute and precise, along with the right codes. It is also beneficial to know that under the Merit Based Incentive Scheme Payment and value-based care, the cost of overall healthcare will see a reduction.
The Centers for Disease Control and Prevention and Medicare has announced the ICD-10 codes for the next year i.e. ICD-10-CM. It contains 422 revised codes, 1943 new codes and 305 codes have been deleted. There are around 121 codes that affect urology. As per urologypracticetoday.com, "Sixty-four of the changed codes were made to the code family of T83 (Complications of genitourinary prosthetic devices, implants and grafts) and T85 (Complications of other internal prosthetic devices, implants and grafts) (added to the list based on the use of InterStim by urologists around the country)." Urology coding should be based on these changes, coders must update their knowledge on the same while the EHRs must be updated with these changes.
Other urology coding pointers:
GP modifier: Used when the patient is treated by a physical therapist or done under an outpatient physical therapy plan of care. In the first case, it is not done by the urologist, but in the second case, it is.
Biofeedback training for bladder symptoms: Use code 90911 for the training of perineal and the urinary sphincter muscular tool. This also includes 51784 and 51785 EMGs. An unbundled code is 97032 which is used in cases of an assisted stimulation by electricity of the various muscle. Under the E&M services, they should not be bundled with 90911 and do not require modifiers. The diagnosis as per audioeducator.com is "stress incontinence, urgency incontinence, mixed incontinence 788.33 and overflow incontinence 788.38."
Penile Trauma Repair: CPT code 54437 is to be coded for traumatic corporeal tear. Code 54438 is to be used for replantation, complete amputation, penis.
As per audioeducator.com, the changes for prostrate conditions, infections and inflammatory reactions are:
Modifier -25 is to be used on all E/M services for minor procedures; E/M services are paid for separately and not bundled with surgical reimbursement (surgery done on same day). Modifier -57 is to be used for an E/M service for major procedures; requires separate billing for E/M and surgery (surgery could be done the next day).
CPT codes 51550-51596 are to be used in case of open or laparoscopic cystectomy. Medicare and other insurance providers also cover Macroplastique as a urethral bulking treatment for adult females with stress urinary incontinence (SUI) primarily due to intrinsic sphincter deficiency (ISD) (auanet.org).
Other coding changes which urology coders must be aware of are in the field of repeat TURPs, multiple bladder tumor, endoscopy of intestinal urinary diversions, stone bladders (depending on the size and complexity of the stone removal procedure required), laparoscopic procedures which do not have a specific CPT code, bladder biopsy becoming a TURB, resection of a bladder neck contraction etc.
With numerous procedures and terminologies used in urology billing and coding, it is imperative that it is done by experts. Medical Billers and Coders make use of the error free EMR/EHR system while applying apt codes and modifiers for efficient and quick billing, generating charge-sheets, mitigating undesirable audit-notices and removing the aspects of delays or denials, thereby increasing revenues for the physician. The various urology disciplines which are dealt with by the team are laparoscopy, endourology, neurourology, pediatric urology, urologic oncology, reconstructive urology, andrology and urogynecology.