Urology Coding Alert

CPT Codes 2002 added language to the surgical guidelines providing useful information on what is and isn't included in the surgical package. Key changes for urologists include 1) the preoperative period includes the day before and the day of surgery and 2) treatment of complications may be reported within the postoperative period with appropriate modifiers.

The global code always includes the following services:

local infiltration or topical anesthesia one related E/M encounter (including history and physical subsequent to the decision for surgery on the date of or immediately before surgery) immediate postoperative care including talking with the family, writing orders, postanesthesia recovery evaluation and "typical" postoperative care.   Anesthesia Is Included in Global Anesthesia by the surgeon is included and not separately billable from the global code, says Michael A. Ferragamo, MD, FACS, assistant clinical professor of urology at State University of New York, Stony Brook. For example, a urologist performs a penile block (64450*, Injection, anesthetic agent; other peripheral nerve or branch), with a combination of lidocaine and Marcaine, and a circumcision (54161, Circumcision, surgical excision other than clamp, device or dorsal slit; except newborn) on a 66-year-old male. You should code only the circumcision with 54161. Because the surgical fee includes the infiltration with the local anesthetic, the physician cannot bill or expect payment from the patient. This includes any supervisory role that the surgeon may have with a certified registered nurse anesthesiologist or other professional.

However, a commercial payer will sometimes reimburse the surgeon for anesthesia or conscious sedation (99141, Sedation with or without analgesia [conscious sedation]; intravenous, intramuscular or inhalation) in addition to the procedure. Under these rare circumstances, regional or general anesthesia (not local) provided by the urologist may be reported by appending modifier -47 (Anesthesia by surgeon) to the basic service. In the circumcision scenario, if anesthesia is provided, code 54161-47. If the urologist provides conscious sedation, report 54161 and 99141. Because 99141 is for the physician performing the procedure, do not use modifier -47. Note: Per CPT, do not use modifier -47 on the anesthesia codes (00100-01999). Decision for Surgery CPT rules for preoperative care now coincide with Medicare rules. According to Medicare, the urologist may bill for related or nonrelated office visits up to the day before surgery, even if the decision for surgery had previously been made. Medicare's processing system does not edit for global visits prior to the day before the major surgery, notes Sandy Page, CPC, CCS-P, co-owner of Medical Practice Support Services, a coding and compliance consultancy in Denver.

Some private payers, however, maintain that once a decision for surgery has been [...]