Urology Coding Alert

This 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.

CMS 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.

Every 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.

ASC 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 Center of Savannah in Georgia.

Although CMS' recent announcement of proposed 2008 ASC changes has shaken ASC coders across the country, the jury is still out on whether the new rules will harm urology coders.

"The chatter in the coding community is back and forth on this," says Chris Felthauser, CPC, CPC-H, ACS-OH, ACS-OR, an independent coding consultant in Eugene, Ore. Whether the changes will affect your bottom line depends on your case mix, he says. "The best thing to do is to look at each practice. I've been taking the surgeon's case mixes and dropping them into a spreadsheet and then loading the fees, current grouper rates, new grouper rates, etc., into that sheet." But it may be too soon to tell how strongly this will affect physicians, he says.

"The changes made to the Medicare payment system did not do what we had hoped for ASCs; however, urology was not hit as hard as some specialties," Shaw says. "I do feel that we need to closely monitor our payments and familiarize ourselves as much as possible with the changes and guidelines involved with implementation of the new payment system and make it as effective as possible for urology."