Urology Coding Alert

Tip: First determine who performed the testsIf you provide in-office urodynamics testing, there's no time like the present to make sure your coding is up to speed. Multiple urodynamic testing types and physician supervision rules can throw a wrench into your coding works.Learn how to correctly code for these often-lucrative tests with this real-world case study.Review the Urodynamics CaseScenario: A patient presents to your office for urodynamics testing on a day when the urologist is suddenly called out of town.Problem: Therefore, ancillary staff performs the tests while no physician is present in the office. "My understanding is that you cannot bill for this without a doctor in the office. Could we bill at least a component of that, the technical component?" asks Jennifer Vander-horst, CPC, coder for Michigan Urological Clinic in Grand Rapids, who presented this case study.Note: See the shaded box below for information on how to choose a specific urodynamics procedure code.Sort Out Supervision RequirementsNonphysician practitioners (NPP), or ancillary staff, can perform urodynamics studies and be paid for the service as long as you follow physician supervision rules. The supervision level your urologist must provide for urodynamics studies depends on the study type, says Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology at the State University of New York in Stony Brook.For most urodynamics procedures, your urologist must provide direct supervision. This means the urologist must be present in the office suite but not necessarily in the room where the NPP performs the urodynamics study.Tip: Direct supervision doesn't mean that the interpreting/ordering physician necessarily has to provide the supervision, says Elizabeth Hollingshead, CPC, CMC, corporate billing/coding manger of Conrad Urologic Inc. in Marysville, Ohio. If the physician who will read or interpret the study is not performing the tests, bill the technical component under the physician who is present in the office at the time of the study and the professional component under the interpreting/ordering physician.Exception: Your urologist must provide personal supervision -- meaning he must be in the room where the NPP is performing the procedure -- for a needle EMG (51785, Needle electromyography studies of anal or urethral sphincter, any technique) or a voiding cysto-urethrogram interpretation (74455, Urethrocystography, voiding, radiological supervision and interpretation).Bonus: As of Jan. 1, 2000, a physician assistant (PA) may perform the technical component of diagnostic tests under general supervision as allowed under state law where the PA practices. And if state law permits, a nurse practitioner (NP) or clinical nurse specialist (CNS) may personally perform diagnostic tests without documentation of physician supervision, Ferragamo says.Watch for Carrier-Specific Coding RulesHow you'll code and the payments you can expect for urodynamic studies will depend on the medical personnel performing the study and the insurance carrier [...]