Urology Coding Alert

Do you know when the 1997 Documentation Guidelines pay more for a service than the 1995 guidelines? Did you know there is more than one way to code a bilateral procedure? It may be time for you to review often-overlooked facets of coding it just might save you a bundle.

In a teleconference titled "Don't Let Your Urology Claims Go Down the Drain," C.J. Wolf, MD, CPC, emphasized the importance of the following three means of achieving optimal reimbursement for your coding practices. 1. Know When '97 Reimbursements Are Worthwhile Though urologists think the '95 Documentation Guidelines are easier to comply with, the '97 guidelines offer oft-overlooked reimbursement advantages. But when urology offices become too familiar with one set of guidelines, they forget the potential advantage of using the neglected set of guidelines.

This lapse often plagues practices coding the genital urinary exam. Here's why. The physical exam component is the primary difference between the '95 and '97 Documentation Guidelines. The '95 guidelines do not offer adequate single system exam requirements that recognize the genital urinary exam as a higher-paying exam unless it is combined with a complete system exam. In contrast, the '97 DGs consider site-specific, detailed exams like the genital urinary exam worthy of a higher-paying code. More specifically, the genital urinary exam would be coded 99202 under the 1995 DGs, but the same exam would be coded 99203 by the 1997 guidelines a $30 difference. Don't worry about alternating between the '95 and '97 guidelines, because Medicare now endorses both equally for E/M codes. Medicare supports alternating between sets of guidelines because of reimbursement discrepancies in the two sets of guidelines. It's up to the physician to determine the set of guidelines used for a given encounter, Medicare asserts, as long as only one set of guidelines is used in any given encounter. 2. Avoid Claim Denials By Knowing Global Remembering which global periods are attached to urological procedures may seem like a no-brainer, but the number of reimbursement opportunities missed because of mixed-up global periods tells another story. Let's take a look at procedures whose global periods may surprise you. Example 1: A patient in his mid-30s presents with curvature of the penis. The physician determines the cause to be internal tissue that has turned to scar tissue on one side of the penis. The physician decides to treat this condition, Peyronie's disease, with an injection, 54200* (Injection procedure for Peyronie disease). 54200 has a  10-day global period.

Many coders assume injections have a 0-day global period because they are quick and common procedures, often performed by a nurse or physician assistant, Wolf says. When the 10-day global period for 54200 is mistaken for a [...]