Urology Coding Alert

Multiple procedures do not necessarily mean multiple payments from carriers, particularly for related endoscopies performed on the same day or session. But you dont have to give up on reimbursement either. By using modifiers correctly and adjusting, urologists can maximize their billing for these multiple claims.

There is a lot of confusion about whether to use modifier -59 (distinct procedural service), modifier -51 (multiple procedures), or no modifier at all with multiple endoscopies. If the payer is not Medicare, but commercial, you need to find out how it wants you to bill these procedures. Although you should not use modifier -51 when billing Medicare for multiple procedures within the same coding family, commercial payers may have different policies.

For commercials we bill the regular fee without making any adjustments and without any modifiers, says Jackie Shovan, CPC, financial counselor with the division of urology at the University of Utah in Salt Lake City. We know that the payers will always subtract the base code.

Fee Adjustments

For example, the base code for cystoscopy is 52000 (cystourethroscopy [separate procedure]). But many times this code will not be filed at all. Instead, you might file any one of the other procedure codes that encompasses a cystoscopy. Do not append the modifier -51 in these casesthat will reduce your payment by half. In some specific circumstances, modifier -59 is appropriate when billing multiple endoscopic procedures (different sites, for example).

To avoid inappropriate bundling and to ensure proper reimbursement urologists should reduce the fee for the base procedure if is is included in more than one of the procedures they are billing. Even with procedures that are not bundled, you need to reduce the fee for the base procedure. If the urologist performs 52260 (cystourethroscopy, with dilation of bladder for interstitial cystitis; general or conduction [spinal] anesthesia) and 52007 (cystourethroscopy, with ureteral catheterization, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with brush biopsy of ureter and/or renal pelvis), it is not the same as 52204 (cystourethroscopy, with biopsy), which is a regular biopsy of the bladder. If youre already in there with the scope and you do a biopsy, thats just part of the code, says Susan Callaway-Stradley, CPC, an independent coding consultant based in North Augusta, S.C. But 52007 is a particular type of biopsya brush biopsyand its for the ureter and renal pelvis, not just the bladder, she says. Urologists should code these two procedures as follows:

You need to make sure you are not billing twice for the base codethe cystoscopy (52000). But this isnt done via a modifier. Medicare will do it for you by adjusting your fee. Do not adjust the [...]