Urology Coding Alert

Question: Please address the following scenarios regarding the application of HCFAs rule for teaching physicians (Supervising Physicians in Teaching Settings; Endoscopy Procedures). While waiting either for the technician or waiting for the radiology procedure to be completed, the teaching physician (TP) leaves cysto room A to perform another cystoscopy in cysto room B. The TP then returns to complete the cysto in room A. Can procedures performed by the TP (in rooms A and B) be billed for reimbursement?

Scenario 1: A resident under the supervision of a TP performs a cystourethroscopy in cysto room A. The resident inserts the scope and after initial review, the TP decides that a radiologic procedure is needed. A radiology technician is called but one is not available and the physician must wait.

Scenario 2: The radiology technician comes immediately to the cysto suite and administers a dye for uro flow drainage. The drainage takes approximately one hour.

Texas Subscriber

Answer: All procedures can be billed as long as the TP is present during the key portion of the procedure. He does not have to be present the entire time. The question has always been What is considered the key portion? That varies by each physician. Usually, if a TP documents his presence during the procedure, it is OK to bill. He also should document his participation with the procedure. He can be supervising more than one resident at a time.