Urology Coding Alert

If a lithotripsy patient is admitted to the hospital during the global period for post-procedure pain, urologists cannot bill for a second procedure. But if the complication requires a return to the operating room, the second procedure is billable, says Susan Callaway-Stradley, CPC, CCS-P, an independent coding consultant in North Augusta, S.C.

Sometimes after lithotripsy (50590lithotripsy, extracorporeal shock wave), a patient experiences pain and must be admitted to the hospital. This can happen the same day or the day after the procedure. But lithotripsy has a 90-day global period; that means all care rendered that is related to the procedure is covered by the procedure itself.

You cant bill for any of it except the lithotripsy itself, says Brenda Oliver, billing office manager for Pioneer Valley Urology of Springfield, Mass. Sometimes the patient is admitted by the primary care physician (PCP), in which case you dont have anything to do with the case unless the PCP calls you in to consult, Oliver notes.

If you have to admit the patient to the hospital for a reason that has nothing to do with the lithotripsy treatment, then you could bill for the admission and the subsequent hospital visits, explains Traci Evans, office manager for State College Urologic Associates of State College, Pa. But if the pain is caused by stones, then it would be related and cant be billed for, she says.

Some commercial insurance companies consider typical post-operative pain to be non-billableunlike wound infections, for example, says Callaway-Stradley. Checking with the payers up-front to see what their interpretation is might be a good idea, she says. In general, however, the rule of thumb is that evaluation and management (E/M) services are not billable within the global period. Even if a bedside procedure is performed in the hospital, such as a catheterization, the physician would not be paid, she adds.