Urology Coding Alert

Get the scoop on limited vs. complete.

Radiological imaging is a given in urology practices, so if you don’t know how to properly code the many possible radiology services your urologist provides, you’re costing your urologist money. 

Solidify your urological radiology know-how with these three expert tips. 

1. Watch for Written Reports

When your urologist performs a radiology procedure in the office or in a facility, such as the hospital, he should be paid for that work. “Urologists may bill and are entitled to be paid for radiological interpretation,”, explains Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology at the State University of New York at Stony Brook. 

If the radiological service meets the following criteria, you should bill for your urologist’s work:

• The urologist should do the initial interpretation or reading of the film if you are billing for that work.
• Ensure your urologist provides a written report, which can be part of an operative note, of his interpretation. The report must be written, dictated, and signed by the interpreting physician, and it must be an integral part of a radiological service and interpretation. Keep this report in the chart, separate from office notes. 
• The radiological reading should directly contribute to the diagnosis or treatment of the patient’s condition, and your urologist should act clinically based upon the reading of the image as noted in his report. 
• The urologist must meet any accreditation requirements. Certain studies such as MRI, PET, and nuclear studies require accreditation before a urologist can perform the interpretation. Payers may also have their own accreditation requirements. 

Additionally: Medicare requires an order in the medical records as well as a signature for all diagnostic tests ordered, so look for an order for each test and either a handwritten or electronic signature on your urologist’s orders for radiology studies. “Without a signature, medical records will need to show clear documentation of medical necessity for a test or have an attestation statement in the medical record,” Ferragamo explains.

2. Append the Right Modifier

There are three options for reporting and seeking payment for a radiological service: 

• Technical component — This portion of the service’s payment covers the ownership of the equipment, payment for a technician, and payment for a contrast agent if administered.  
• Professional component — This portion of the service’s payment covers the work involved in reading and interpreting the study. 
• Global — This portion of the service’s payment covers both the technical and the professional components. 

When your urologist performs the radiological study in the office, where the practice owns the equipment, report the procedure code as global with no modifiers. 

Example: Your urologist performs a retrograde pyelogram in the office. He owns the x-ray equipment. Report 74420 (Urography, retrograde, with or without KUB) without a modifier, since the urologist owns the equipment and also interprets the study.

For radiology services your urologist performs in an ambulatory surgical center (ASC) or in the hospital, where the facility owns the equipment, you’ll report the procedure code with modifier 26 attached for your physician’s work. The facility will report the same procedure code with modifier TC (Technical component).

Example: Using as example similar to the one above, your urologist performs a retrograde pyelogram in an ASC. Report 74420 (Urography, retrograde, with or without KUB). Append modifier 26 (Professional component) to the 74420, since your urologist read and interpreted the x-ray, but the facility owns the equipment.

Remember: If your urologist performs the radiological procedure in the office, you should not count the procedure as part of the E/M service. Instead, separately bill both an E/M service, if provided, and the radiology code. You will not need to append a modifier to the E/M code to seek separate payment. “Be sure, however, that your urologist documents a separate note for the radiological portion of the encounter on a separate page from the E/M note,” Ferragamo says. Also, keep the images and x-rays in the patient’s medical records.  

3. Differentiate Limited and Complete

Your urologist must perform and document a full evaluation of all anatomic regions (all organs) covered in the code you are billing. If an area or organ is described as “not seen,” the physician should explain the reason, such as overlying gas or overabundance of fatty tissue.

If your urologist doesn’t document all of the required radiological elements in his report, you need to consider the procedure a limited study, rather than complete, and assign the appropriate limited code. See the table below for more details. 

For example, if your urologist performs a retroperitoneal ultrasound study but only visualizes the kidneys, you should report 76775 (Ultrasound, retroperitoneal [eg, renal, aorta, nodes], real time with image documentation; limited) for a limited retroperitoneal ultrasound study rather than 76770 (... complete) for a complete study.  

Note: Urologists should not order complete female pelvic exam per American Urological Association (AUA) guidelines, Ferragamo says.