Urology Coding Alert

You could be missing out on up to $350 per study by incorrectly coding in-office tests Many urologists consider urodynamics sessions a cost-effective way to bring in additional revenue and serve patients. Your challenge is to determine how you should report these in-office services. Follow these expert tips and you'll be sure to see a flood of new reimbursement.
 
Note: Take a look at "Differentiate Between Urodynamics Tests and Codes to Ensure Clean Claims" on page 59 to learn the differences between various urodynamics studies and the codes you should report. Question: Can we expect payment when our office's PA performs the study? Nonphysician practitioners (NPP) such as physician assistants (PA) can perform urodynamics studies and be paid for the service as long as you follow a few rules. The level of supervision your urologist must provide for urodynamics studies depends on the type of study, says Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology at the State University of New York in Stony Brook.
 
For most urodynamics procedures, the urologist must provide direct supervision for a nurse, nurse practitioner (NP), medical technician or PA. This means the urologist must be present in the office when the NPP is performing the urodynamics.
 
Alternative: Your physician must provide personal supervision -- meaning he must be in the room where the procedure is being performed -- for the following procedures:
 
A needle EMG (51785, Needle electromyography studies of anal or urethral sphincter, any technique).
 
A voiding cystourethrogram interpretation (74455, Urethrocystography, voiding, radiological supervision and interpretation). You should also report 51600 (Injection procedure for cystography or voiding urethrocystography) for the injection procedure. Exception: As of Jan. 1, 2000, a PA may perform the technical component of diagnostic tests under general supervision as allowed under the law of the state in which the PA practices. An NPP may bill for the technical component with modifier TC (Technical component) and receive full reimbursement, and a physician may bill for the professional component with modifier 26 (Professional component).
 
And if state law permits, an NP or clinical nurse specialist (CNS) may personally perform diagnostic tests without documentation of physician supervision, Ferragamo says.
 
PAs may also personally perform diagnostic tests, but they must be under general supervision of the physician. The Medicare Carriers Manual, Part 3, Section 2070 (now Medicare Benefits Policy Manual, Chapter 15, Section 80) states, " although an NP, CNS, and PA may not supervise an RN or medical technician for the performance of diagnostic tests under the diagnostic tests benefit (Social Security Act, section 1861[s][3]), these practitioners may provide personal supervision in the absence of a physician as provided under 1861(s)(2)(K) when under these circumstances 1861(s)(3) does not apply."
 
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