Urology Coding Alert

Question: Can a consulting urologist charge for postoperative visits when another surgeon performed the surgery or admitted the patient to the hospital? Our surgeons are under the impression that no physician should bill post-op charges, but I disagree. Which of us is correct?

Illinois Subscriber

Answer: If another surgeon, such as a general surgeon from another practice, asks for the urologist's opinion about a specific problem during the postoperative period of a surgery the requesting surgeon performed, you can report the service as a consultation (99241-99255).
 
Following the consultation, if the urologist provides further care for a urological problem, you may report his services in this postoperative period whether these visits be in the hospital (99231-99233, Subsequent hospital care) or in the office (99211-99215).
 
Alternative: If, however, there is no specific reason for a urological consultation, and the other surgeon is only asking the urologist to provide the postoperative care, it would be a transfer of care. In that case, you cannot report a consultation code or bill separately for any postoperative care.
 
Modifier rundown: To report his postoperative care of the patient, the urologist should append modifier 55 (Postoperative management only) to the surgical procedure code with the date of surgery listed as the date of service.
 
The surgeon who performed the procedure would bill for the surgery with modifier 54 (Surgical care only) to show that another physician performed the postoperative care. If the surgeon did provide some but not all of the postoperative care, he would also report the surgical procedure code again on a second line with modifier 55, indicating the limited days for which he provided postoperative care.
 
Remember that there must be a formal transfer of care and the date of transfer noted in the medical records, and the surgeon and urologist must indicate in box 19 on their 1500 forms the date of transfer and the dates of postoperative care each may have provided.