Urology Coding Alert

Question: If my urologist provided a preventive physical exam on the same day as an E/M service, can I append modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to the E/M code?

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Answer: There are definite requirements for appending modifier -25 to E/M codes when your physician also performs a preventive physical exam, and because of the rarity that a urologist performs these two procedures together, it is a good idea to make sure you know those requirements before submitting the claim.

You can append modifier -25 to E/M codes when your physician also performs a physical exam, as long as the E/M service performed and documented was a separately identifiable evaluation.

To qualify a service as separate, your physician should identify a medical condition, and evaluate, manage and treat the patient. Make sure you match an ICD-9 code to the E/M level of care for the medical problem. Report this separate diagnosis for your E/M code in addition to the preventive V code for the physical exam and the procedure code. Use a sign and symptom code for the diagnosis, in the absence of a confirmed diagnosis.

Though this method exemplifies correct coding, you may not get paid. Rarely do urologists perform preventive physician exams, because these services are typically rendered by patients'internists and general practitioners. Urologists may see patients yearly, but these visits are typically for specific problems such as an enlarged prostate, 600.0, or chronic prostatitis, 601.1.

Answers to You Be the Coder and Reader Questions contributed by Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology, State University of New York, Stony Brook; and Morgan Hause, CCS, CCS-P, privacy and compliance officer for Urology of Indiana LLC, a 19-urologist practice in Indianapolis.