Q.
If a cystoscopy is being performed for follow-up on a patient who has a history of bladder cancer and no evidence of recurrence is found, is it correct to use the diagnosis code V10.51 (“history of bladder cancer”) or 188.8 (“bladder cancer”)? We are an ambulatory surgery center, bill the facility fee, and use the V code, while the physician’s office is using the 188.8 codes. We recently received multiple Medicare claim denials for incompatibility of the two codes. The physician wants us to use the 188.8 code and we are concerned that this is incorrect.
A.
Billing a diagnosis of cancer for a patient who has at one time been diagnosed with cancer is a point of debate in many specialties. Each cancer is viewed differently, and specialty organization consensus among providers is currently the single best source of information for appropriate cancer diagnosis use.
A diagnosis of bladder cancer does not have a specialty consensus for use. In lieu of a specialty society-recommended policy, the physician responsible for the care of the patient is responsible for the correct diagnosis.
In this case, coverage is not an issue for Medicare, as screening cystoscopy is covered under either diagnosis. The liability of the diagnosis is the physician’s. Therefore, we do not see a risk for the facility coding the doctor-selected diagnosis.
Q.
I am new to urology coding, and wondered if one could bill for a penile block when performing a meatotomy. I am also unsure about which nerve the penile block falls under. The urologist gave the penile block for postoperative pain control. 64430 is used for a pudendal block, and 64450 is for a peripheral nerve; I thought the latter would be correct. When I run codes 53020 and 64450 through the CCI edits, a modifier –59 can be appended to 64450 to bypass the edit, but I was unsure if this was appropriate to control post-op pain. Please give your opinion as to which code should be used and whether modifier –59 would be appropriate.
A.
Unfortunately, you should no longer charge for the penile block while performing a meatotomy. CPT includes the local infiltration in the surgical package. Medicare has gone one step further and bundled the injection code into the procedure.
You are correct about the nerve block. The correct code is for the injection of the anesthetic into the nerve is 64450. 64450 is included (bundled) in 53020. The CCI edits state that it can be removed from the bundle and billed separately by appending the –59 modifier to 64450. Unfortunately, it would be inappropriate to add the modifier –59, because the injection is being performed in conjunction with the meatotomy and is not an unrelated or “distinct” procedure. You cannot use a modifier unless the circumstances surrounding the services meet the definition of the modifier. Just because the edits say you can does not mean you should.
Control of post-op pain is usually considered follow-up care similar to wound care, removal of sutures, and other related services. However, many offices are billing and being paid for pain control services under the auspices of care above and beyond what is normal. Although you may be successful in payment for these services, the cost and effort for providing these services is minimal and should be included.
Q.
Please educate me about ICD-10, which I hear we will be required to use. What is it, and when are we going to have to use it?
A.
ICD-10 actually has two separate parts: diagnosis and procedures. Currently, there are no plans to adopt the procedural part of ICD-10. If adopted, it would take the place of CPT, and there is a lot of support for continuing CPT.
The diagnosis portion of ICD-10 will be adopted at some point, although the projected dates keep changing. It was originally scheduled to be adopted this year, and now it appears that implementation has been delayed until 2012. The reason for shifting to ICD-10 is that the system is much more exact than ICD-9-CM and will be expandable to include all future diagnoses. It is based on an alphanumeric system and will be more specific for each diagnosis. Some believe it will be much easier to use, and it will certainly be much easier to add new diagnoses.
Q.
I am a compliance and coding educator for a urology department. A provider is looking for in-depth education on urodynamics coding and denial problems, but Iam having a difficult time finding any information on this subject.
A.
There are a number of different resources available for assistance on urodynamics coding, including resources through two AUA web sites http://www.auanet.org/ or http://www.auacodingtoday.com/. A document developed by AUA that can be found on either site specifically addresses urodynamics coding.
In addition, AUA seminars provide excellent information regarding coding services specific to urology and payment policies. The authors of this article also provide consulting and training services for urology.
Urologist Ray Painter, MD, is president of Physician Reimbursement Systems, Inc., in Denver and is also publisher of Urology Coding and Reimbursement Sourcebook
Mark Painter is CEO of PRS Urology SC in Denver.
Disclaimer:
The information in this column is designed to be authoritative, and every effort has been made to ensure its accuracy at the time it was written. However, readers are encouraged to check with their individual carrier or private payers for updates and to confirm that this information conforms to their specific rules.
