Urology Times
Over the years, we have heard many urologists say, “I don’t do coding; my coder does that, my billing service does that, etc.” We agree that urologists do not have to be expert coders to do their part in the coding and billing process. However, for practicing urologists who are interested in maximizing their income legally and ethically, it’s important to understand some of the coding process.
The billing process is very complicated, with close to 20 separate tasks that have to be performed precisely and accurately for the process to be successful. The urologist only has to complete four of those tasks:
Identify all services performed
Document completely all services
Determine whether there are any unique circumstances related to any of those services
Communicate those services and circumstances to your billing staff.
This process does not require a rocket scientist, nor the expertise of a certified coder. These tasks can be accomplished quickly, efficiently, and accurately with a little pre-planning and a willingness to change old habits. As noted, you do not have to code for your services per se; however, it is important that you identify all services that you perform. Creating a communication sheet.
There are a finite number of surgeries that each urologist performs on a routine basis. You can easily identify those by looking at all surgeries performed the previous year. Once those procedures have been identified, sit down with your coder and your billing staff to develop an individualized superbill or “communication sheet.” This can be formatted to hold all, or at least 90%, of the surgeries that you usually perform. Work with your coder to ensure that the codes are accurate and up to date. Include the appropriate ICD-9 diagnosis codes on the same sheet.
This step is very important each year. We have found a number of cases where the coding staff has identified a service with an incorrect code, which is perpetuated throughout the practice. Without review, the mistake can be repeated easily, adding thousands to the lost revenue column.
After the team has identified and coded correctly all procedures you’d normally perform, format it into a communication sheet (see http://urologytimes.com/communicationsheet). Now, you are in the position to perform your tasks without having to reinvent the wheel each time you perform surgery, which, in essence, is what happens if you or your staff has to look up the CPT codes after each surgery.
The urologist’s coding tasks
Once you have your communication sheet, you’re ready to complete the tasks that will allow your billing staff to accurately code for services:
Identify all services performed. Take out the communication sheet with the patient’s name and identification information and mark each procedure that you have performed. It’s very important that you identify all procedures and mark them on your communication sheet.
For those who are averse to “doing your own coding,” keep in mind that you are merely identifying all services, assuming your procedures were “pre-coded” prior to the surgery.
Document completely all services. When you dictate, be sure that you have properly documented all services. Your office may need that documentation to appeal a service that is improperly reimbursed or denied. If so, payment will depend on the completeness of your documentation.
Determine whether there are any unique circumstances with any of those services. Now is the time to determine whether there are any unusual circumstances that would assist your coder/billing service to submit a “clean claim” that will get you paid for all services that should be paid. This is a very important step, particularly in billing private payers. In order for your staff to properly bill with the appropriate modifier, you must separate each of the secondary procedures performed that were a necessary part or component of the primary procedure from those procedures that require separate effort and should be billed in addition to the primary procedure. You should not be paid for components and you should not waste your staff’s time billing for them.
Again, this is a very simple process:
1. Identify the main procedure and mark it on the sheet.
2. Look at each of the other procedures that you have performed and ask yourself, is this a component of the main procedure (ie, were you required to do the secondary procedure in order to accomplish the primary procedure)? If it is a component, then you can’t charge for it separately, so simply draw a line through it to let your staff know not to bill separately.
3. Conversely, if the second procedure is not a component of the primary, then you need to communicate to your staff that they should bill for that procedure in addition to the main procedure. The best way to communicate that would be to attach “–B” or some other identifier (eg, the –59 modifier) to each of the secondary procedures that should be billed.
4. Communicate those services and circumstances to your billing staff. Simply give this sheet to your staff and let them finish the job.
Now that you have identified all services, documented completely each service, and have tied your circumstances specifically to the services you intend to have billed, you have provided your staff with all the information they need from you in order to accurately submit a “clean claim.” Your staff then has only to look up the billing rules and determine which modifiers, if any, are needed to submit the claim to that payer according to that payer’s rules.
