Urology Coding Alert

Know modifiers, allowable codes for ASC paymentThis year is a year of change for your ambulatory surgical center (ASC) coding, but some coding rules have stayed the same. Reinforce your ASC knowledge with these four tips.1. Turn to the Web for an ASC-Allowed ServiceCMS will pay a "facility fee" for 790 additional procedures performed in ASCs in 2008, including more than 60 that apply to urology. For example, in 2008 you'll be able to bill Medicare for facility charges when your surgeon performs a laparoscopic orchiopexy (54692) or a voiding pressure study (51795) in an ASC.Go online: To review the full list of surgeries added to the ASC list, visit the Federated Ambulatory Surgery Association (FASA) Web site online at http://www.fasa.org/additions.pdf.Medicare also keeps the full list of allowable ASC procedures on its Web site, according to the year that the physician performed the service. Visit the CMS site http://www.cms.hhs.gov/ASCPayment/ for the full list of ASC-allowed procedures.2. Abide by the 'Same-Day Global' RuleEvery procedure billed by the ASC has a "same-day" global period. This makes sense because the ASC is not reporting physician work services -- only facility fees. This applies to the coder assigning codes for the ASC, but not the coder assigning codes for the physician who performed the service.For instance, if a patient has postoperative bleeding and the urologist must return the patient to the ASC for control of bleeding on the same day as the procedure, both the physician's coder and the ASC's coder should report the appropriate control-of-bleeding procedure code appended with modifier 78 (Unplanned return to the operating/procedure room by the same physician following initial procedure for a related procedure during the postoperative period) because the procedure occurred within the same-day global period for the ASC.If, however, the urologist returned the patient to the ASC the day after the initial surgery, the ASC coder would report the appropriate control-of-bleeding code with no modifier attached. For the ASC's purposes, the initial surgery's global period has expired, even though the surgery includes a 90-day global period for physician services. On the other hand, the urologist's coder would report the bleeding-control code with modifier 78 appended because the physician's services still fall within the global period.Takeaway: The ASC coder should follow the same-day global rule, but the physician's coder should follow standard global period rules from the fee schedule.3. Discontinued Coding Modifiers May DifferASC coders may occasionally use modifier 52 (Reduced services) but won't use modifier 53 (Discontinued procedure). Instead, insurers usually require ASC coders to call on modifiers 73 (Discontinued outpatient procedure prior to anesthesia administration) or 74 (Discontinued outpatient procedure after anesthesia administration), as appropriate, says Robin Shaw, billing manager for the Urology Surgery [...]