Urology Coding Alert

Question: My doctor was called in after another doctor had performed a laparoscopic supracervical hysterectomy. The other physician requested my urologist consult at the end of his procedure in the ambulatory surgery center. The consult was considered an intra-operative consultation and evaluation. My doctor decided to do another surgery at that time, and the patient was prepped and returned to surgery. I was wondering how to report the consult. I have my surgery codes but am not sure about this consult because the patient was not an inpatient and was already out of surgery when my physician went to consult and then decided to do another surgery. Would you help me with this coding?


Georgia Subscriber

Answer: Because the patient was not an inpatient, you should use the outpatient CPT codes for this consultation. Choose your code from 99241-99245 (Office consultation for a new or established patient...) based on the service level your urologist provided. Most intraoperative consultations should be billed at a level two or three because the physician usually cannot perform a full history and examination on a patient who is under anesthesia.

Don't miss: If the consultation leads to a surgical procedure, as in your case, you need to add a modifier to the consultation code to be paid for the consultation billed on the same day as the operative procedure.

If the procedure that the urologist determined was necessary during the consultation has a zero- or 10-day global period, add modifier 25 (Significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service) to the consultation code.

If the procedure has a 90-day global, append modifier 57 (Decision for surgery) to the consultation. Properly adding one of these modifiers will ensure payment for the consultation as well as the surgical procedure.