Urology Coding Alert

If 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.

Scenario: 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.

Nonphysician 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.

How 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 involved, Ferragamo says. In this case study, a member of your ancillary staff performed the urodynamics test when the urologist was not present in the office, so you'll choose from the following coding scenarios.

Option 1: For Medicare, if an NPP such as a PA or NP performs the urodynamics study, you should code the appropriate urodynamic code under the name and National Provider Identifier (NPI) number of the NPP with modifier TC (Technical component). You will receive 100 percent of the allowed payments for each urodynamic study. Then, you should also code for the professional component of the urodynamics test in the name and number of the NPP using the procedure code with modifier 26 (Professional component). You'll receive 85 percent of the allowed payments for the professional portion of this case.

Option 2: When a nurse or medical technician performs the study, and the physician is out of the office at the time of the testing, you cannot code for any of these services to Medicare. If, at a later date, the urologist reads and interprets the study, you can report that service. You would code the appropriate urodynamic procedure code in the urologist's name, appending modifier 26 to indicate he only interpreted the study.

Option 3: For private non-Medicare carriers, you should check with the payer to see how you should report urodynamics services. If the carrier allows a PA, NP, medical technician or nurse to perform the study, there usually needs to be physician supervision, Ferragamo says. "Often, this means that the physician may not have to be in the office but must be close enough to return to the office to assist if necessary," he says. Therefore, you would report the appropriate urodynamics code under the name and NPI number of the "supervising" physician, not the NPP.

Caution: "Of course, no charges can be made in the name of the nurse or medical technician" since they do not have their own NPI numbers, Ferragamo says. "This also is the case when the private carrier does not credential the NPP."