Urology Coding Alert

When a urologist visits the emergency department (ED), coders are faced with a wide variety of codes to choose from. There are many different alternatives, and urology coders must choose the right code depending on the circumstances to receive optimal reimbursement and to avoid fraud.

The following details some of the circumstances that may be involved when a urologist is called to the ED:

1. Consultation: If the ED physician has already seen the patient and requests that the urologist see the patient, the urologist may bill an outpatient consultation (99241-99245), says Elaine Bloom, account representative for State College Urologic Associates, a three-urologist practice in State College, Pa. The requirements for a consultation must be followed: The ED physician must be soliciting the urologists opinion or advice (not simply transferring care), the urologist must document the request and reason for the consultation, and he or she must prepare a written report for the ED physician. It doesnt matter whether the patient is new or established. A typical example of an ED consultation for a urologist is when a patient complains of abdominal and flank pain and the emergency room physician asks the urologists opinion about whether it is renal colic.

Note: If the patient is discharged from the ED, use the outpatient consultation codes.

2. Emergency services visit: Sometimes, the patient shows up in the ED, and the ED physician doesnt see the patient. Instead, the urologist is called right away. In that case, the urologist should bill an ED services code (99281-99285) or a new patient code (99201-99205). You have to be careful not to bill an emergency code if the emergency room doctor saw the patient, Bloom says. If that happens, then the emergency room doctor wont get paid. Note that Medicare will pay for two emergency department codes, and some private payers will as well.

In fact, in this scenario, the emergency room physician usually doesnt see the patient at all, explains Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology at the State University of New York, Health Science Center in Stony Brook. The nurse in the emergency room does the triage, and she calls the urologist because she knows this is a urology patient, Ferragamo says.

The encounter in the emergency department does not have to be an emergency in order to bill emergency services, Ferragamo says. You may just be in that location for your convenience or the convenience of your patient. Sometimes the problem occurs on a weekend, and its easier for doctor and patient to get to the emergency department of the hospital than it is for them to get to the office. Some payers, however, [...]