Urology Coding Alert

Figure out if your practice is losing money with this consultation scenario.Reporting the wrong level of services for your urologist's E/M visits can cost your practice hundreds or even thousands of dollars every year. If you consistently downcode, you're losing money. If you consistently upcode, you're setting yourself up for possible audits and fines.Good news: But don't worry. If you remember a few key pointers about E/M coding, you'll be sure to choose the correct level of service every time. Take a look at this sample scenario, and find out what the experts have to say about what you need to look for in the urologist's documentation to support your code choice.Scenario: Another physician asks your urologist to provide a consultation on a patient with kidney stones. The patient has other factoring problems, namely diabetes, COPD, and hypertension. Usually based on the patient's presenting problem, you most likely will code a level-three office consultation (99243). However, because of the other problems, your urologist suggests a level-four code (99244). Even though he is not treating the diabetes, COPD, or hypertension, the urologist feels those conditions do influence his choice of therapy for the urological problem and would affect his medical decision making (MDM).Focus on 3 Key ComponentsWhen you're assigning an E/M code for your urologist's services you need to look at the three key components of the visit: the history taken at the time of the visit, the extent of physical examination, and medical decision making.Depending on the type of service your physician provided, you'll need to make sure the visit satisfies two or three of those elements before you choose a code. For office or other outpatient visits for established patients, you must meet the criteria for two of the three key components to bill for a specific level of care, says Christy Shanley, CPC, CPC-URO, billing manager for the University of California, Irvine, department of urology.You Need More Than 1 Element to Code High-LevelDespite having a higher level of MDM in this scenario, the information about the rest of the visit seems to indicate that the history and exam portions of the visit would not be higher than a "normal" 99243 visit. Therefore, even though the MDM might be higher, you would still choose the lower code, says Marcella Bucknam, CPC, CCS-P, CPC-H, CCS, CPC-P, CPC-OBGYN, CPC-CARDIO, manager of compliance education for the University of Washington Physicians (UWP) and Children's University Medical Group (CUMG) Compliance Program.Why: The documentation requirements for a level-three consultation are a detailed history, detailed exam, and low-complexity decision making. The documentation requirements for a level-four consultation are a comprehensive history, comprehensive exam, and moderate decision making. "Although a higher level of decision making is one [...]