Coding for the Young Pediatric Urologist SPU Webinar, May 2020

The webinar is available for members of the SPU and can be accessed online in the members-only area. 

During a new visit or consult, if a patient is recommended a circumcision, it should be billed as level 3 — because circumcision is considered a minor surgery due to its short global period of 10 days. If the patient is recommended a steroid cream, it should be level 4. For reassurance, it should be level 3.

In the case of hypospadias, if the patient is recommended surgery is level 4 — because hypospadias is considered major surgery and has a global period of 90 days–, reassurance is level 3.

Dr. Campbell from Colorado provided this useful list:

CONSULT/NEW PATIENTS

Assumptions= History and examination meet criteria for level of service determined by medical Decision making.

Prepuce

  • Reassurance –level 3
  • Steroid cream (prescription) –level 4
  • Surgery (in clinic or OR) — level 3 (minor surgery/global <90 days)

Phallus (hypospadias, torsion/angulation)

  • Reassurance –level 3
  • OR — level 4

Testis

  • Retractile: level 3
  • OR: level 4

Varicocele

  • Review of images, f/u w/o images — level 3
  • Review of images, f/u with imaging — level 4

Antenatal hydronephrosis

  • Review of images w/additional w/u — level 4

UTI’s, dysfunctional elimination syndrome (w or w/o VUR)

  • Review of labs and images, w/additional w/u: –level 5
  • Review of labs and images, w/o additional w/u: — level 4
  • OR: level 4

Stones

  • Review of labs and images, w /additional w/u — level 5
  • Review of labs and images, w/o additional w/u — level 4
  • OR
    • ESWL, PCNL: level 4
    • Ureteroscopy — level 3 (minor surgery/global <90 days)

Those undergoing surgery may be increased 1 level if identified risk factors and documented appropriately.

ESTABLISHED PATIENT

Document status of 1-2 chronic conditions OR a brief HPI (1-3 elements) and ROS (1 system)

  • Postoperative visit (outside global period)
    • w/o imaging
      • stable –level 2
      • worsening — level 3
    • w/imaging/review of images –level 3
  • Other — level 3

If established (see by another provider in the group within 3 years) but new to you, use Established patient codes and bill level of service as per Consult/New Patient codes.

 

Changes coming in 2021

History and examination, when performed will have to be medically appropriate and not just to fulfill the criteria. Billing will be driven by medical decision making.

Time will be total time (not limited to face/face) (e.g chart review, consultation with a colleague), limited to DOS. This will be offset by a higher threshold for each LOS (9-14 minutes longer per LOS)

 

Global period

  • 0, 10 or 90 days
  • 0,10: minor surgery (circumcision, ureteroscopy). The provider needs to be present during the entire procedure.
  • 90: major surgery (orchiopexy, augmentation). The provider needs to be present for critical portions of the procedure.
  • Cannot bill for routine postop care or care of complications (outside the OR) during the global period.

 

Office procedures

  • LOA uncircumcised: 54450 (foreskin manipulation)
  • Labial adhesions: 56441

Modifiers

E and M modifiers

  • 21 for a prolonged visit (this can be used instead of coding for time)
  • 24 unrelated E and M during the postop global period
  • 25 significant, separately identifiable E and M service by the same MD on the same day as the procedure or other service.

Surgical

  • 22 unusual prolonged procedure (redo case or complicated case)
  • 50 bilateral procedure
  • 53 aborted procedure
  • 58 staged procedure (lap orchiopexy)
  • 79 unrelated procedure by the same MD during the global

Hypospadias

  • 54324 for hypospadias repair
  • 15740-51 for island flap harvest
  • 14040-59 for Byars flap to cover deficient skin
  • The codes above are all associated with the diagnosis of Hypospadias, penile; congenital chordee; and deficient foreskin.

 

 

 

Leave a Comment