Urology Coding Alert

Pitfall: Watch out for payer-specific rules, however.

Multiple codes, code additions and deletions, and required modifiers make coding uroflometry a challenge even for veteran coders. A change to the global period assignment for CPT 51736 (Simple uroflowmetry [UFR] [eg, stop-watch flow rate, mechanical uroflowmeter]) and CPT 51741 (Complex uroflowmetry [e.g., calibrated electronic equipment]) makes things a bit easier.

Read on to find out what you need to know about how global periods affect your uroflometry coding.

Learn What Changed With 51741

In the January 2011 release of the Medicare Physician Fee Schedule, CMS changed the global periods for both 51736 and 51741 from 000 to XXX.

CMS drastically reduced the reimbursement you receive for both simple and complex uroflowmetry for 2011. "But in doing that they put the code in the category of 'global concept does not apply'," explains Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology at the State University of New York at Stony Brook.

Note: The change to XXX applies to the global codes (51736 and 51741) as well as their professional and technical components. That means that whether you bill 51736/51741, 51736/51741-26 (Professional component), or 51736/51741-TC (Technical component) there is no global period associated with these flow rate measurements.

Differentiate XXX From 000

Although both XXX and 000 global periods appear free of global bundling issues, you should know that there is a distinct difference between the two.

The classification XXX means that the service is truly free of global surgical bundling issues, and you can separately report services that your urologist performs on the same date as the surgical procedure (such as E/M services).

"The XXX value has always meant that the global concept doesn't apply to the procedure," stresses Alice Kater, CPC, PCS, coder for Urology Associates of South Bend, Ind.

The 000 indicator applies to the date of the procedure only. Therefore, Medicare will bundle all services that the physician performs on that surgery date into codes with this indicator.

"000 is for endoscopic procedures or minor procedures" explains Chandra L. Hines, business office manager at Capital Urological Associates in Raleigh, N.C. "If you have a code with a zero day global period include related pre operative and post operative care on the day of the procedure only."

How other global periods work: Major surgical procedures (including common urological surgeries such as prostatectomies and nephrectomies) include a 90-day global period (90 days plus the day before the surgery). Lesser surgical procedures  may include a global period of 10 days (e.g., 11420, Excision, benign lesion including margins, except skin tag [unless listed elsewhere], scalp, neck, hands, feet, genitalia; excised diameter 0.5 cm or less) or zero days (e.g., 52001, Cystourethroscopy with irrigation and evacuation of multiple obstructing clots).

Note: The YYY global period applies only to unlisted-procedure codes (such as 51999, Unlisted laparoscopy procedure, bladder) and indicates that the payer is free to determine a global period for the procedure.

The ZZZ designation denotes an add-on procedure for which the global period is included in the primary procedure.

Know When You Can Leave Modifiers Off

Uroflowmetry is the measurement of the flow rate or the speed with which urine is voided/expelled from the urinary bladder. You will often report 51736 or 51741 along with an E/M service.

With the new XXX global period designation you can now report 51736 and 51741 with an E/M visit without appending 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 E/M code.

Example: Your urologist sees a patient who is having difficulty urinating. He performs a level-three established patient visit and a uroflow. For Medicare, you no longer need to use modifier 25 on the E/M code when you report it in conjunction with uroflow 51736 or 51741, so just report 99213 for the office visit.

"We have billed and continue to be successfully reimbursed for 51741 when performed the same day as an office visit when appropriate," Kater says.

See if Your Payer Has Any Exceptions

A handful of payers might actually require you to append modifier 25 to the E/M code in claims that also include procedures with XXX globals. Starting several years back the Correct Coding Initiative (CCI) indicated that XXXglobal- day procedures do have a minor E/M associated with them, just like zeroglobal- day procedures. Therefore, some payers will still require modifier 25 for a separately identifiable E/M service accompanying procedures with XXX globals.

Good practice: Verify your private payers' policies before you code your next claim. You can find global-period information in the Medicare Physician Fee Schedule Database, available as a free download on the Medicare Web site at http://www.cms.hhs.gov/PhysicianFeeSched/. To find global-period information, you should look to the column of the database labeled "Global Days."