Physician in office should charge for that day’s services

Also, advice on billing for marker seeds and national figures for E&M services

Q

I work for two urologists. We have changed our schedule so that one physician is always in the office when we administer leuprolide acetate injections and perform uroflows, catheterizations, and other procedures. Who should charge for the service?

A

Congratulations on making the schedule change to be sure one of the urologists is in the office during these procedures. All services, including the shots, should be charged as if provided by the physician in the office. It does not matter who the patient’s physician is or who ordered the test.

Q

We have recently begun placing fiduciary (inert marker) seeds prior to radiation therapy with transrectal ultrasound guidance. We have trouble identifying the proper codes for marker seed placement. Code 55859 seems specific for brachytherapy. Please help.

A

Unfortunately, there is no code for placement of marker seeds. I am unaware of any coding options other than using the enlisted code and sending all the documentation to the insurance carrier or medical director. Explain why you are placing the markers, and ask for payment.

Also, if you feel this is going to become a common practice, I would suggest that you also write a letter to AUA explaining the procedure and request a new code.

Q

The physicians in my office are interested in the percentage graph for E&M codes and how they compare with the national graph, which would help them with coding. When coding E&M services, there should be a well-rounded, bell-shaped graph. What are the national figures for that graph?

A

The latest Medicare data that I have are from 2001. The frequency that urologists code each level of their E&M services is in a bell-shaped curve for both established patients and outpatient consults. However, both curves are skewed.

For the established patients, almost 50% were charged as level three, with more at level two than level four. For the outpatient consult, again, close to 50% were charged as level three; however, there were more level fours than level twos.

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.