Urology Coding Alert

Test your coding knowledge.  Determine how you would code this situation before looking at the box below for the answer.
Question: Can we raise our fee to commercial payers for stent insertions? We have been billing 52351 as primary and CPT 52332 with modifier -51 appended.

Georgia Subscriber

Answer: You can always raise your fee, but you will only get what the plan pays for each code.
 
If you are saying that private payers allow more for 52332 (cystourethroscopy, with insertion of indwelling ureteral stent [e.g.,Gibbons or double-J type]) than for 52351 (cystourethroscopy, with ureteroscopy and/or pyeloscopy; diagnostic), and you report reduced fees for modifier -51 (multiple procedures) services, change the reporting sequence by billing 52332 as the primary procedure and 52351 with modifier -51.
 
If you are saying that the payer allows 100 percent of the billed charges, you could raise your fees. It can be done, depending on the method the practice uses for establishing/updating fees. Remember, however, not to charge a Medicare patient more than you would charge any other patient.