Urology Coding Alert

When your urologist makes the 'decision for surgery' matters.

When your urologist performs an evaluation and management (E/M) service, one of the first questions you should ask before you start coding is whether the patient is still under a global period limitation from a previous or upcoming surgery.

Getting to know seven types of global periods Medicare assigns to procedure codes, will help you quickly determine whether you can actually report an E/M code. You'll see fewer denials, avoid the stress of worrying whether an audit will uncover services you shouldn't have billed, and ensure you aren't missing out on services you should be billing.

Count Your Days for Major or Minor

Of the several different types of global periods Medicare has established, three represent the number of days of postoperative care included in the fee for the initial procedure, as described below.

000: This period indicates that related preoperative and postoperative care on the day of the procedure is included in the fee for the procedure itself. Any related evaluation and management work done on the same day as a procedure with this global indicator is generally included, says Maggie M. Mac, CPC, CEMC, CHC, CMM, ICCE, president of Maggie Mac-Medical Practice Consulting in Clearwater, Fla., and Brooklyn, N.Y.

Example: Under Medicare guidelines, 52001 (Cystourethro-scopy with irrigation and evacuation of multiple obstructing clots) has a global period of 0 days. Therefore, any related E/M services provided on the same date of service are typically not separately reportable.

010: This period indicates that Medicare includes 10 days of postoperative care in the payment of a procedure. Any E/M services you perform on the day of the procedure and during the 10-day global period "are generally not separately reimbursed," Medicare guidelines indicate.

Example: Code 11420 (Excision, benign lesion including margins, except skin tag [unless listed elsewhere], scalp, neck, hands, feet, genitalia; excised diameter 0.5 cm or less) carries 10 global days.

Manage 25 With Minor Procedures

Procedures with global periods of 0 or 10 days are generally considered "minor procedures." Because of this designation,

Medicare and other payers do not routinely pay separately for an E/M performed on the same day. They will consider a brief history, limited examination, and minimal medical decision making included in the fee for the minor procedure.

To get paid for a separately identifiable and medically necessary E/M service performed on the same day as a minor procedure, you have to ensure that the E/M was documented as separate and significantly identifiable, in which case you can append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service). "The key is whether or not the E/M was medically necessary in addition to the procedure performed on the same day," says Mac.

Rely On 57 for E/M With Major Procedures

090: Procedures with 90-day global periods have one day of preoperative care and 90 days of postoperative care included in the fee for the initial procedure.

Example: Code 52601 (Transurethral electrosurgical resection of prostate, including control of postoperative bleeding, complete [vasectomy, meatotomy, cystourethroscopy, urethral calibration and/or dilation, and internal urethrotomy are included]) has a 90-day global period.

Codes with a 90-day global period are considered major surgeries. If the decision for surgery is determined by an E/M service performed on the same day or the day before an unscheduled surgery, you should append modifier 57 (Decision for surgery) to the E/M code to receive separate payment for the E/M work in addition to the procedure.

Avoid Pigeonholing Groups

The remaining four global period categories do not have specific time periods for postoperative care attached to them.

MMM: Urology coders will not often find themselves dealing with MMM codes, as this period describes a service furnished in uncomplicated maternity cases including antepartum care, vaginal delivery, and postpartum care. The usual global surgical concept does not apply to uncomplicated vaginal deliveries.

XXX: Codes assigned "XXX" are not subject to the global period concept. This designation is typically seen with E/M, lab, and radiology tests but may be seen with other services, as well, notes Mac.

For example, you'll find an XXX period for uroflowmetry codes 51736 (Simple uroflowmetry [UFR] [eg, stop-watch flow rate, mechanical uroflowmeter]) and 51741 (Complex uroflowmetry [e.g., calibrated electronic equipment]). Therefore, for payment of an E/M service it is no longer necessary to append modifier 25 to an E/M code when also billed with 51736 or 51741.

YYY: This designation means that individual carriers determine the global period. YYY usually applies to unlisted procedures, and the global period a carrier assigns will depend on the type of unlisted service.

For instance, unlisted code 51999 (Unlisted laparoscopy procedure, bladder) carries a YYY global period.

ZZZ: This global period designation means the procedure is related to another primary procedure and falls within the global period of the other service. Only the additional intra-service work to perform this service is included in the work RVU. This global period typically applies to add-on codes, including +57267 (Insertion of mesh or other prosthesis for repair of pelvic floor defect, each site [anterior, posterior compartment], vaginal approach [List separately in addition to code for primary procedure]).

Medicare lists the global periods in its Fee Schedule, but you should ask private carriers for their global periods in writing because they may differ from Medicare's policy.