Urology Coding Alert

Question: Can you charge for an inpatient consult and a bedside debridement on the same day?

Louisiana Subscriber

Answer: You can bill for both services as long as the E/M service goes beyond a simple assessment of the area to be treated. Remember 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 the inpatient consultation code (99251-99255, Inpatient consultation for a new or established patient ...) you report to inform the payer that the surgeon provided a separate E/M service above and beyond the E/M inherent to the debridement.

Report a code from the 11040-11044 (Debridement ...) range, depending on the type and depth of debridement your physician performed. CPT codes 11040, 11041, and 11043 have zero-day globals, while CPT codes 11043 and 11044 have 10-day globals.

Diagnosis help: When you use modifier 25, Medicare does not require different diagnoses for the consultation and the debridement. However, the documentation should show the medical necessity for the surgeon to perform the separate services, and also show that the E/M service provided went beyond the normal preoperative work that is a part of every procedure.

Warning: Additionally, Medicare specifies that the decision to perform a minor procedure in itself is not sufficient justification to separately bill an E/M service. There must be documentation that the service went beyond the evaluation needed to determine the need for the procedure.

Note: Some payers may not require modifier 25 on the consultation service as this represents the initial visit and examination of a patient, and the payer accepts this as a medical necessity before your urologist provides any surgical services.

-- Answers to Reader Questions and You Be the Coder contributed by Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology, State University of New York, Stony Brook.