Urology Coding Alert

Question: My urologist saw a patient in our office for lower urinary tract obstructive symptoms, and then five days later he admitted the patient to the hospital for a planned surgical procedure, a TURP. The TURP was performed the next day. The doctor says that we can bill for the admit, but because the patient was in our office five days earlier and the surgery was planned, I didn't think we could bill for the admit. Am I wrong?


Oregon Subscriber
Answer: Actually, your doctor is wrong. If the surgeon admits a patient to the hospital for a planned, previously explained, accepted and agreed-upon surgery (that is, the decision for surgery has been made), the admission, surgery and discharge from the hospital are all included in the surgical global fee.

Most CPT surgery codes are considered "package" procedures. The surgical package includes the actual surgery, along with the following:
  The E/M service on the day of or the day prior to the surgery (the latter for major procedures), unless that visit led to the decision for surgery
  Local infiltration, metacarpal/metatarsal/digital block or topical anesthesia
  Immediate postoperative care (including dictating operative notes and talking with the family and other physicians)
  Writing orders
  Evaluation of the patient during postanesthesia recovery
  Typical postoperative follow-up care. Example: The urologist schedules a patient for a radical prostatectomy and admits him to the hospital one day prior to the procedure. You should only report 55810 (Prostatectomy, perineal radical). This surgical code includes the hospital admission and discharge, and you should not submit separate codes for them. The history and physical examination the urologist performs when he admits the patient to the hospital is an administrative examination required by the hospital and in this scenario should not generate a specific charge.