Urology Coding Alert

Improper coding of ultrasounds and x-rays could cost you $242 for each prostate biopsy and $120 for each retrograde Proper reporting of radiological guidance and supervision depends on many things -- who did the procedure, where the procedure occurred, and who owns the equipment -- but you can confidently submit claims for these services with these expert guidelines.

"If you plan to report and bill for a radiology code along with a surgery code, the urologist should dictate a full radiology report, which now may be included within the regular operative note," says Michael A. Ferragamo, MD, assistant clinical professor of urology , State University of New York, University Hospital, Stony Brook. Here's how to code a few different scenarios involving two common procedures. Ultra-Effective Ultrasound Coding A urologist performing 55700 (Biopsy, prostate; needle or punch, single or multiple, any approach) usually uses ultrasonic guidance to help him place the needle correctly (76942, Ultrasonic guidance for needle placement [e.g., biopsy, aspiration, injection, localization device], imaging supervision and interpretation), along with a transrectal ultrasound to evaluate the prostate for abnormalities (76872, Ultrasound, transrectal).

If both of these radiological procedures are medically necessary -- and they are, in most cases -- you can separately report both. How you code the procedures depends on which of the following scenarios your documentation reflects:

1. Procedure done outside the office with a radiologist: If the urologist performs the biopsy in a hospital or other facility where he does not own the radiological equipment, and a radiologist performs and interprets the ultrasound tests, you can only report CPT 55700 for the biopsy, says Debi Wagner, CPC, biller and coder for the Southern Ohio Medical Center in Portsmouth. The facility documents the radiologist's supervision and interpretation of the imaging procedures and reports codes CPT 76872 and 76942.

2. Procedure done outside the office without a radiologist: If the urologist performs the biopsy and the imaging procedures in a hospital, using equipment he does not own, without the help of a radiologist, you can report codes 55700, 76872-26 and 76942-26, Wagner says. Modifier -26 (Professional component) shows that the urologist does not own the equipment.

3. Procedure done in the office without a radiologist: If the urologist performs the ultrasounds and the biopsy with equipment that he owns, you can report 55700, 76872 and 76942 without any modifiers, says Sue Scott, CPC, business office manager for St. Louis Urological Surgeons in Chesterfield, Mo.

"We do the procedure in the office with our own equipment," she says, "so we use all three codes without modifiers." In this case, the urologist is performing both the technical and professional components of the procedures -- in other words, the entire procedures -- and should bill [...]