Urology Coding Alert

Are you missing out on hundreds? Now's the time to find out Coding cystoscopy is likely second nature for you because urologists frequently perform this procedure. But are you sure you're capturing every dollar your physicians deserve when they perform multiple cystoscopic examinations in one surgical session? If not, you could be leaving $150 or more on the table. Follow this expert advice to ensure that you know when you should -- and shouldn't -- report multiple endoscopic procedures. Keep Coding All in the Family Cystoscopy, urethroscopy and cystourethroscopy are all endoscopic procedures. And the first question you need to ask when coding multiple endoscopic procedures during the same surgical session is: Are the endoscopies the urologist performed in the same code "family"? Rule #1: If the answer is yes, the multiple-scope rule specifies that you cannot report the base, or "parent," code separately with a more extensive endoscopy in that same code family. Example: Your urologist performs a cystourethroscopy (52000, Cystoure-throscopy [separate procedure]), followed by a cystourethroscopy and bladder biopsy (52204, Cystourethroscopy, with biopsy[s]). Report only 52204 because that code already includes the work described by the diagnostic cystourethroscopy code (52000). In other words, 52000 is the "parent" code and you should not report it separately. "You will only be paid for CPT code 52204 even if billed with 52000. The carrier will deny payment for the 'base' code 52000," says Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology, State University of New York, Stony Brook, N.Y. Note: Most private payers also follow the multiple endoscopy rule, says Jill Young, CPC-EDS, CPC-IM, of Young Medical Consulting in East Lansing, Mich. Always check your payer's guidelines to be sure. "Ask them, or bill a few claims to see how they pay," Young says. Don't Double-Dip on Diagnostic Scopes You should always consider a diagnostic endoscopy as part of any surgical endoscopic procedure your urologist performs, according to CPT rules, says Kelly Young, a coder with Scottsdale Center for Urology in Scottsdale, Ariz. The national Correct Coding Initiative (CCI) bundles reflect this rule, Jill Young adds. In other words, when your urologist performs multiple endoscopic procedures from the same family during the same encounter, the base or parent code (usually the diagnostic procedure) is included within the more extensive same-family procedure codes. Rule #2: With endoscopic procedures that have the same base code, you won't receive full payment for each of the endoscopic codes. The multiple-scope rule specifies that Medicare will pay the entire fee schedule amount only for the highest-valued endoscopy in a given code family during the same operative session. Medicare will reimburse any additional endoscopies in the same family by subtracting the value of the base [...]