Urology Coding Alert

Question: Can my urologist bill for immunosuppressant visits during the global period following a kidney transplant?

California Subscriber  

Answer: A provider may separately bill for visits involving immunosuppressant therapy that occur during the 90-day global period of a kidney transplant. In fact, the Centers for Medicare & Medicaid Services (CMS) included this policy in a Change Request (4143) issued in Medicare Benefit Policy Transmittal 50: “Immunosuppressant therapy for kidney transplant is not included within the 90-day global period.”

However, you must make sure to have the correct modifier appended to these claims. You’ll find all Medicare Administrative Contractors (MACs) and (most) commercial payers have guidelines that advise the use of modifier 24 (Unrelated evaluation and management service by the same physician or other qualified health care professional during a postoperative period) for immunosuppressive therapy visits following transplants during the global period timeframe.