Urology Coding Alert

Question: Is there a code to bill if a patient comes in to learn how to use a penile pump or would that be included with the E/M visit? Can we bill a 99211 if a MA or PA does the teaching?

Oregon Subscriber

Answer: The teaching of how to use a penile pump would be included in the E/M service code you report (99211-99215, Office or other outpatient visit for the evaluation and management of an established patient …, or 99201-99205, Office or other outpatient visit for the evaluation and management of a new patient …).

You only can bill for a medical assistant (MA) doing the teaching using 99211for any and all time spent if the physician is in the office suite. A physician assistant (PA) could also bill using 99211 or even 99212, depending on the time spent. For a PA providing the service, you may bill "incident-to" in the name and identification number of the physician if he is in the office suite and receive 100 percent of the global fee, or bill only in the PA’s name and number if the physician is not in the office and receive 85 percent of the global fee.

Warning: Most of these scenarios assume that the physician has provided initial care with a specified plan of treatment for which the MA or PA is continuing to provide to the patient.