Urology Coding Alert

Brush up on your modifiers, coders: You are your practice's best line of defense against charging out claims that payers may deny because of modifier mistakes. Modifiers "ensure that there is accurate reimbursement" for services rendered, says Catherine Brink CMM, CPC, president of Healthcare Resource Management Inc., in Spring Lake, N.J. Modifiers indicate to the payer that though the CPT Code accurately applies to a procedure or service, the physician did something a little bit different from normal. Sometimes this difference warrants increased reimbursement. That's why everyone in your office needs an adequate knowledge of these coding "enhancements," says Victoria Jackson, administrator and chief executive officer of Southern Orange County Pediatric Associates in southern California. Check your modifier knowledge before you post any more inaccurate claims: Take this short five-question True/False test to see where you stand. Answers are provided by Jackson and Brink.
1. You can append modifier -22 to all services, including services that are not primary.
2. Modifier -21 appended to an E/M code indicates a very prolonged service. Use it for time spent on an E/M service that doesn't warrant bumping up your code to a higher level.
3. If you have multiple procedures provided by the same provider on the same day, use modifier -51.
4. If the physician determines that he doesn't need to do the full procedure once the procedure has started and the patient is already under anesthesia, you should append modifier -52 to that procedure code.
5. If one physician revises a urinary cutaneous anastomosis, and a general surgeon repairs the associated parastomal hernia, append the second code with modifier -80. And now for the answers. 1. False: You should append modifier -22 (Unusual procedural services) only to your primary service, if it is greater than what is normally performed. The primary service can have any length of global surgical period. For instance, you can append -22 to services like endoscopies. You can also use -22 with assistant-surgeon services. You shouldn't, however, append modifier -22 to secondary services.

"Use of modifier -22 will demand medical review by the carrier," says Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology, State University of New York, Stony Brook. "Send a paper, not electronic, claim and include the operative report and a short, simple layman's-terms note indicating the circumstances, i.e., bleeding, postradiation, etc." The additional documentation will substantiate the extra work, he adds, and most important, mention the extra operative time at least 150 percent more that was required for the extended procedure. 2. True: Modifier -21 (Prolonged evaluation and management services) is used when a face-to-face or floor/unit service is provided. If the [...]