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need help with the order of procedures

  1. Default need help with the order of procedures
    Medical Coding Books
    Please help me!

    Here's the order of procedures done, according to the post operative report:

    cystourethroscopy 52000
    electromyogram of anal/urethral sphincter 51784
    uroflow-complex 51741
    cystometrogram - complex 51726
    bladder voiding pressure 51795
    rectal and/or intraabdominal voiding pressure 51797

    How do I bill this? The insurance is Medicare and FL Medicaid.

    Is the below correct? What about the modifers?


    I feel like I might need a modifer 59 somewhere? Can anyone shed some light on this for me? I am still new to coding and only a CPC-A.

  2. #2
    You need to take several steps to determine what order your coding should be in.

    First start with your RVUs - these are the values that Medicare uses to determine which code goes first. To find these, go to CMS, click on Medicare then in the right hand column is Medicare fee for service payment - go down the list until you find physician fee schedule. Open this file and then on the left hand side of the page go down to PFS relative value files.

    When you click on that link up will come a bunch of years. You want to go to page 4 for 2009 codes. Pick the last one in the bunch and open it - it is a zip file. You have to pick a file out the bunch offered, open the last one prior to the PDF file.

    The RVUs for facility fully implemented are in column S. This will let you determine the order to bill in.

    Next you need to know if there is any bundling going on. This is also on the CMS website. After you click on Medicare, go down the left hand side until you come to "Coding", under tht you will see National Correct Coding Edits. Open this and then check all your codes in both the column 1/column 2 format and in the mutually exclusive. At the top of the page will be the modifiers that let you know if you can't break the bundle, if you can if you meet the requirements (need to know exactly what modifier 59 means - it is in CPT appendix A).

    Once you have this step accomplished, you have your order and your modifiers.

    Hope this helps.


  3. Smile
    Yes, this really helps. Thank you so much, Carol.
    - Suzanne, CPC-A

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