Urology Coding Alert

Tip: Check for transfer of care before reporting 99241-99245

Knowing what not to report is just as important as knowing what to report when you're dealing with prostatitis treatments. If you report a consultation code without first ensuring the office visit meets consultation criteria, or if you neglect to report signs and symptoms of prostatitis and report only a probable diagnosis, you'll be facing a slew of denials.

To be certain that you're not falling into the prostatitis coding pitfalls, follow these three expert steps. Step 1: Look First at 99241-99245 for Initial Visit The first time your urologist sees a patient for prostatitis will likely be at the request of the patient's primary-care provider (PCP). The PCP may request a consultation because the patient has symptoms such as frequency, urgency or dysuria, and elevated prostate specific antigen (PSA), and the prostate may be enlarged and/or extremely tender.

If the patient's visit to your office meets the consultation requirements, you should report your urologist's service with a consultation code (99241-99245, Office consultation for a new or established patient ...). (See "Keep Consultation Requirements Straight With 5 Basics" on page 92 for more on consultation requirements.)

"If a patient is in for prostatitis, with no other urological complaints, the average code we use is 99243," says Kelly Young, office manager at Scottsdale Center for Urology in Arizona.

Important: Checking the urologist's documentation is essential when selecting the appropriate consult code level. "Make sure your doctor has documented properly, especially when you are using those higher-level E/M services," Young says. "As the risk and the medical decision-making are not high on prostatitis, it is important to make sure you are choosing an E/M code that will pass an audit."

How it works: In a typical prostatitis case, if a PCP refers the patient to your urologist, the urologist will document the request and write a letter to the referring physician reporting his findings.

Remember: Your urologist can provide treatment after a consultation as long as there is no "transfer of care." See "Treatment, Tests Don't Mean You Can't Code a Consult" on page 91 for more on consultations and treatment.

Alternative: If the visit does not qualify as a consultation, you should report the appropriate new or established patient office visit code (99201-99215).

"There are the patients who are self-referred because of symptoms, and they feel that they need to see a urologist," says Nancy Griffin, MA, CPC, billing manager for five physicians at the Swedish Urology Group in Seattle.

You may also see referrals from the emergency department for patients with acute prostatitis, which again would not be a consultation because of the referral source. Step 2: Decipher Between Prostatitis and BPH If you can't [...]