Urology Coding Alert

Question: We are getting denials from Medicare carriers when we bill office consultation code 99244 with catheterization code 53670 on the same day. They are telling us we need to use a modifier on the consultation code. We have never had to do this in the past what is going on?

New Jersey Subscriber

Answer: It sounds as if either your carrier has switched to a new computer system for processing claims or maybe they have incorporated a new auditing tool in any case, you're going to have to alter your coding practice and start using modifier -25 when billing 99244 and a catheterization.

It is not uncommon for carriers, even Medicare carriers, to require you to 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 consultation codes when they are rendered on the same day as a procedure such as a catheterization. In fact, you should feel lucky that you are not dealing with a private carrier, many of whom refuse to pay for consultations and catheterizations regardless of whether you append modifier -25.

For your Medicare carrier, you will not need to have different diagnosis codes to link to the consultation and the catheterization. For example, if a patient presents in urinary retention, you can use 788.20 as the diagnosis code for both a consultation and a catheterization even if you append modifier -25 to the consultation code.

You should be aware that 53670 and 53675 have been deleted from CPT 2003 and have been replaced by three new bladder catheter codes that describe the exact anatomic location of the catheter insertion, the type of catheter inserted and, in some cases, the reason for the bladder catheter: