Urology Coding Alert

Guest Columnist: Catherine Brink, CMM, CPC

You can set yourself up for clean claims and stop expensive mistakes. The key Know how to accurately assign the right E/M code for your urologist's hospital care.

If you ever find inpatient E/M coding tricky, the answers to the following five questions will help you submit your claims with fewer headaches and better reimbursement odds. Limit E/M Charges to Once per Day Question 1: If the urologist provides an office-based E/M visit and then later in the day admits the patient to the hospital, how can we get reimbursed for all of our work? Do we have to write off the other E/M services that weren't related to the inpatient admission? Answer 1: You don't have to write off the outpatient E/M visit, but you are correct that in most instances you can charge only one E/M visit every 24 hours. Therefore, the work that the urologist performed during the office E/M visit that occurred earlier in the day should be considered when selecting a code for the hospital admission (99221-99223), assuming that the urologist has a face-to-face encounter with the patient during the admission that same day.

The ''combined'' E/M components of the office visit and the hospital admission are the keys that help the physician and the coder select an accurate initial inpatient service code.

Caveat: The rules change if the urologist performed an E/M service in the office on Monday and admitted the patient on Monday, but did not have an actual face-to-face inpatient E/M service until Tuesday. If that occurred, you would charge for the E/M office service on Monday and the initial hospital inpatient admission on Tuesday, because these services did not occur on the same date. Determine Inpatient or Outpatient Status in the Hospital Question 2: A pulmonologist admits a patient to the hospital. The patient suffered a punctured lung during a motorcycle accident, but he also has severe urinary pain and retention. The pulmonologist requests a consultation from a urologist prior to the admission. Should the urologist report a consult, an initial inpatient visit, or a subsequent care hospital visit?

Answer 2: If the pulmonologist requests a consultation from the urologist asking about the severe urinary pain and retention, the E/M service should be documented and charged as a consultation, assuming the urologist correctly documents the required components of the consult codes.

The question is: Should you charge an inpatient consultation (99251-99255) or outpatient consult (99241-99245)? To determine the answer, first find out the patient's status when the urologist rendered the consultation.

The solution: If the patient was admitted to observation status,the consultation would be an outpatient consultation. If the patient was formally admitted as an inpatient, you should report an inpatient [...]