Urology Coding Alert

1. Billing the same code again and again. If all of your patients are level four or five, you've got trouble, but the same is true if they're all level two or three, says consultant Maxine Lewis, BA, CMM, CPC, CCS-P, with Medical Coding Reimbursement Management in Cincinnati.

2. Hospital admissions. Often, physicians don't understand how much documentation they need to provide to justify a hospital admission. You need a comprehensive history and a comprehensive examination to justify a level-two or -three hospital admission, and one of those is often missing, says Barb Pierce, coding and reimbursement director for Professional Management Midwest in Omaha, Neb.

3. Consults. Now that the rules for consults have recently changed, you need to make doubly sure you have the request for a consult documented in your files and in the requesting physician's files.

4. Canned documentation. If you have a template that you use for visits, make sure your urologist doesn't just keep reusing the same answers. If a patient comes in with pain during urination, and the doctor has already checked the box that says "no urinary pain," it won't justify the work your physician did, Lewis says.

5. Illegible documentation. If the auditors can't read your urologist's writing, they won't bother to audit the chart -- they'll just throw it out, Lewis says.

6. Blank documentation. You choose an x-ray code by the number of views the physician performed, Lewis says. But often a physician will leave the number of views blank, and an auditor will downcode that claim to a lesser fee such as for two views, the minimum amount, she adds. Cystography (74430) requires a minimum of three views.

A failure to document the presence of these views may lead to a decrease or even a full denial in payment. Also, some physicians fail to document when they interpret an x-ray, so they lose money every time.

7. Tests documented but not done. The chart may show that your urologist ordered a test, but then there's no follow-through -- for example, if the patient just decides not to go for the test. Come up with a system to make sure the patient actually has the tests after the physician orders them.

8. Time-based coding. If you're billing for counseling and coordination of care, you're entitled to bill based on time alone, if the time spent counseling and coordinating care constitutes more than 50 percent of the encounter time. But you should make sure the physician has documented the total time spent with the patient and how much of this time was face-to-face counseling and coordination.

9. Teaching physicians. Pierce still sees charts in which the teaching physician has written, "Agree with above," after the resident's documentation. CMS has clarified that the teaching physician has to write something more positive indicating that he personally saw and examined the patient.

10. Undercoding. If you're undercoding all of your visits, that's just as illegal as overcoding because you have to code according to what your urologist documents.