Urology Coding Alert

Question: Our urologist is thinking about doing urodynamics in an ASC. Can you tell me if our reimbursement will be the same as if we performed the procedures in our office and also if the applicable codes would be subject to multiple payment rules?

Washington D.C. Subscriber

Answer: Most urologists don’t perform urodynamics studies in an ambulatory surgical center (ASC), but rather perform these tests in their office, presumably because of the higher reimbursement paid when performed in an office setting.

If you do these procedures in an ASC, you’ll be paid less as you can only bill for the professional component using modifier 26 (Professional component). Therefore, you will only be paid for the professional component, and not the technical. The ASC will bill for and receive payment for the technical portion of the procedures using modifier TC (Technical component). If you do urodynamics in the office, you receive the full global payment since you are using your own equipment.

These procedures also follow the multiple procedure rules. Payers will pay 100 percent for the first procedure and then 50 percent for each additional code reported.

Money matters: Payment for urodynamics performed in an ASC will be about one-third of payment in the office. The actual fees are the same in an ASC as in the office, but reimbursement is different in the ASC because of the modifier 26.