Urology Coding Alert

Question: Urologist A saw a patient in the hospital as a consultation because he had urethral trauma resulting from pulling out his Foley catheter. A few days later urologist A saw the patient again and is charging 99232. Later that same day, the patient went into urinary retention and urologist B who is also from our practice performed a complex Foley catheter placement. Urologist B wants to bill 51703. Can both doctors from the same practice have a charge for the same day?

Maine Subscriber

Answer: Yes, both urologists can bill their services on the same day because one performed an evaluation and management (E/M) service and the other performed a procedure. Urologist A should report 99232 (Subsequent hospital care, per day, for the evaluation and management of a patient …) and urologist B should bill 51703 (Insertion of temporary indwelling bladder catheter; complicated [eg, altered anatomy, fractured catheter/balloon]), as you suggested.

Note: If both urologists had performed an E/M service on the same day for the same patient, you could not report both services because they are physicians of the same specialty in the same practice. In this case, you would combine the work performed by both to obtain a level of service and just bill one E/M code under one of the urologists.

Caution: For some payers, you may need to add modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service) to 99232 to indicate that the E/M service is a separate service on the same day as the catheter procedure. Payers often consider working together as partners in the same practice and same specialty as one billing person. Even though the urologists have different NPI numbers, both bill under the practice’s tax ID number. Some payers to which you bill services on the same day but at different times will reimburse based on the date of service not on the time of day the service was performed on the same day. That means that the payer would consider the E/M bundled with the procedure unless you add modifier 25.