Urology Coding Alert

Winner takes all when submitting claims for interpretation of radiological services. If you want to be reimbursed for your next claim, you'd better be sure it's the first one of its kind to reach the payer.

Many urologist don't realize that they can code and bill for the professional component of radiological services they perform outside the office, such as in a hospital setting - they also overlook some requirements for in-office radiological services, says Michael A. Ferragamo, MD, clinical assistant professor of urology at the State University of New York, Stony Brook. To obtain reimbursement for radiological services, urologists must meet certain criteria. Get Paid for Facility Radiology Readings The key to reimbursement when coding physician interpretation of radiological services in a facility setting is the "professional component" modifier, -26. But to use modifier -26 and earn the additional payment that comes with it, physicians must meet the following criteria, Ferragamo says. First and foremost, it must be the urologist who does the initial reading and interpretation of the film.

The second requirement of the physician is that she act clinically on the interpretation made from the initial reading. For example, if the urologist reads a retrograde pyelogram and discovers that a patient has a stone, she must then decide to remove the stone, to place a stent or, if the retrograde pyelogram is normal, to terminate the procedure. All of these examples constitute clinical action. And third, the urologist must write a radiological report similar to that which is required of a radiologist, which is either separate from or a distinct section of the operative report, Ferragamo says. Although in the past carriers required that the radiological report be written on and submitted as an unattached, distinct report, Medicare carriers will now accept the report if it is included in the body of the operative report with some indication, such as a subheading, that it is the radiological interpretation. For example, if the urologist provides a consultation in addition to the professional component of a radiological service, the radiological report can be included in the consultation report, or if in a hospital environment in the progress notes. Debbie Stephens, CPC, a urology coder in Georgia, cautions coders to watch where they tread when appending modifier -26 to a radiological code. The urologist's reimbursement for his in-hospital service such as a retrograde pyelogram, 52005 (Cystourethroscopy, with ureteral catheterization, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service), includes within the "surgical fee" the injection of contrast agent for which one cannot and should not bill separately. In the past, urologists dictated what was seen on the retrograde pyelogram, i.e., "once the dye was injected no obstruction was noted." [...]