# need help with the order of procedures



## suzannereed (Sep 19, 2009)

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?

51726
51795-51
52000-51
51784-51
51797-51
51741-51

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.


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## ccourtney (Sep 19, 2009)

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.

Carol


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## suzannereed (Sep 19, 2009)

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


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