Urology Coding Alert

Question: We had some patients show up for urodynamics in our office at times when the doctor was called out of town. Therefore, no doctor was present, and our ancillary staff performed the tests. My understanding is that we cannot bill for this because a doctor wasn't in the office. Could we bill at least the technical component?

Michigan Subscriber

Answer: How you report urodynamics studies and what payments you can expect will depend on the person performing the study in the office, the supervision level, and the insurance carrier involved. For Medicare, if a nonphysician practitioner (NPP) such as a physician assistant (PA) or nurse practitioner (NP) performs the study, you can report the technical components of the urodynamics studies.

You'll append modifier TC (Technical component) to each urodynamics study and bill in the PA's name and NPI number. You can expect 100 percent of the allowed payments for each urodynamics study when you report them this way.

Don't forget: You should also report the urodynamics codes with modifier 26 (Professional component) for the professional component (tracings interpretation) in the PA's name and NPI number. For this part of the service, you'll receive 85 percent of the allowed global payments.

Reasoning: In this case, the PA is performing and interpreting the study himself when the physician is not present in the office. Therefore, you have to bill under the PA's NPI number and name.

When a nurse or medical technician performs the study and if the physician is out of the office when the study is performed, you can't report any charges. At a later date if the urologist reads and interprets the study, you can code for only the interpretation of the urodynamics study using modifier 26 and billing in the urologist's name.

Alternatively: If private non-Medicare carriers allow the NPP, medical technician or nurse to perform the study "under supervision of the physician," and the urologist is close enough to return to the office to assist if necessary (but not in the room or office), you can bill under the name and NPI of the "supervising" physician and not the NPP. Follow these coding principles and policies when the private carrier does not credential the NPP. If the private carrier follows Medicare rules and policy or does credential the NPP, then follow the coding as explained above for a Medicare carrier.