It is critical in today’s economy to get accurate, entitled, and timely reimbursements for all the healthcare services provided. Billing demands accuracy, and the financial strength of any practice depends on the same, including urology.
Here are ways in which Urology Billing errors can be minimized:
1. Patient Information:
A very common error, but committed many a time! Obtain the correct demographics of the patient along with insurance information, social security number, and valid address. Take SOAP (subjective, objective, assessment, and plan) notes from the physician after the patient’s visit. Information gathered not only aids in apt reimbursement but also assists in urology claims’ approval within the patient’s insurance coverage.
2. Healthcare Centers’ Information:
One’s own records while filing claims must be verified. This includes the healthcare center/practice’s correct name, address, contact numbers, identification numbers, and EDI (electronic data interchange) processing numbers.
3. Resubmission of Denied Claims:
If a claim has been denied, it needs to be looked at thoroughly again before resubmission to the insurance payer; reasons are as common as missing or incorrect coding. It is imperative to verify with a urologist as to which diagnosis codes must be used against the illness.
4. Double Bill:
Do not double-bill; this is especially the rule for some specific provisions of insurance payers. Medicare and other insurance payers do not reimburse or have very clear instructions on billing for postoperative visits.
5. Clearinghouse:
In urology billing, using a clearinghouse is next to mandatory, and exudes competence and avoidance of errors. An efficient clearinghouse will verify claims before final submission; and in case of any errors, they notify the urology billing departments. This drastically reduces the number of time in weeks it might have taken, had the claim with the incorrect or missing information/codes been proceeded/filed for submission with the insurance payer.
6. Coding Errors:
a) Modifier 25 is incorrectly used on almost 35% of the claims. Errors must be avoided by using this modifier only in cases of 0 or 10-day global procedures, there are two problems co-existing but separate diagnoses, the modifier is used with E/M when the problem prompts this along with a minor surgical procedure along with a full urological examination.
“As Per Medicare Claims Processing Manual (100‐04) Section 40.1 (C) Minor Surgeries and Endoscopies: Visits by the same physician on the same day as a minor surgery or endoscopy are included in the payment for the procedure, unless a significant, separately identifiable service is also performed.” (intermoutainphysician.org).
For office E/M and Cystoscopy EOB, use modifier 25 and bill the E/M service if is not connected to surgery and if the visit is medically necessary even if the surgery has been performed. Sometimes, modifiers 25 and E/M will be denied for services provided on the same day. In this case, try modifier 57.
b) Modifier 59: “Medicare has stated that modifier 59 is ‘…appropriate…on a bundled procedure for payment… if procedures are performed for lesions anatomically separate from one another.. in the same organ.” (intermountainphysician.org). For payments of bundled procedures, they must be performed on the same day, must be different procedures, and separate sites in a single organ, etc.
c) Modifier 76: This is to be used for ‘repeat procedures’ or services imparted by the same surgeon, on the same day and at the same time as the initial procedure. For Medicare: “As of July 1, 2013… modifier 59 ( for a distinct service) is no longer considered a valid repeat modifier. Procedures billed with modifier 59 will be denied as exact duplicates. To avoid these denials on repeat…same exact… procedures, you may bill using only a 76 modifier (repeat service)…” (intermountainphysician.org).
7. Complicated Catheterization:
51703: This code is to be used only in cases of instating lubricant in the urethra, catheter removal, and replacement has been complicated, catheter passed over a guidewire or code catheter.
8. Cystoscopy/Biopsy vs. TUR of Bladder Tumor:
52204 and 52224: These procedures can never be billed together but as a bundled procedure.
9. Skin Lesions:
For immediate closure (deep and layered), use 12041 to 12047. For complex closures (involving debridement, scar revision, undermining, and retention sutures), use 13131 to 13133. Confirm if modifier 59 must be used or not for lesion excision and repair. Use 14040 for tissue shift or reorganization with the defect being small.
Billing errors are costly, delay payments, and raise red flags for audits. Urology billers and coders must be aware of the latest terminologies and coding compliance to garner maximum revenues.
