Urology Coding Alert

A small global period and a V code can help bring in an extra $38 per patient

Follow-up visits after ureteropelvic junction (UPJ) surgeries are common - and the key to getting reimbursed for them is proving medical necessity.
 
Although it certainly has characteristics of major surgery, antegrade endopyelotomy (50575, Renal endoscopy through nephrotomy or pyelotomy, with or without irrigation, instillation or ureteropyelography, exclusive of radiologic service; with endopyelotomy ...) has a 0-day global, which means there is an opportunity for reimbursement for follow-up services.
 
If the doctor sees the patient in the office several days after performing CPT 50575 , you may bill for that service. The question is: What is the medical necessity for this visit? "The patient doesn't have a UPJ obstruction anymore," says Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology at State University of New York, Stony Brook. "Most often the patient now is totally asymptomatic and the urine is clear."
 
ICD-9 solution: Report ICD-9 Code V58.76 (Aftercare following surgery of the genitourinary system, NEC), Ferragamo says. "Aftercare means that the patient has not healed or recovered completely and is being seen in the office outside of the global." The most likely CPT code to report would be an office visit at the 99212 level, Ferragamo says.