Urology Coding Alert

Question: My physicians go to our office in a neighboring state to see patients. There, our urodynamics tech performs the urodynamics test under the supervision of the physician that is there that week. The reading of the urodynamics is done back in our state — a different place of service and different provider. In both locations we own the equipment and pay the employees for the work. I believe because we are in different states, the urodynamics codes should be broken into urodynamics codes with a TC modifier in the other state for the testing, and the same codes with a 26 modifier in our state. In our home office we only do the global code even though one physician is the supervising and another reads. What is the most appropriate way to bill these services?

Oklahoma Subscriber

Answer: Assuming that your physicians are licensed in both states and participate with the same insurance company in both states, it would be correct for you to bill separately the urodynamic studies with the TC (Technical component) modifier used for state one and with modifier 26 (Professional component) for state two.

The places of service will be the same (in office, 11) but with different addresses in box 32. The physicians PIN numbers will be the same for either location but the Tax Identifier Number (TIN) may be different depending how the offices in each different state has been set up.

When the providers perform all urodynamic services in one office, you may use global billing without modifiers even if different physicians (partners/associates) provide the services at different encounters on the same day.