Procedures are always bundled within global periods

Q

All follow-up visits are considered bundled into the global period of certain operations. Does this include procedures? For example, can I bill for a uroflow and bladder scan performed less than 90 days ago on a patient who had a TURP or radical prostatectomy?

A

The answers are yes and yes. Procedures are bundled into the global period of another procedure and will not be paid unless the circumstances justify the use of one of the modifiers that will pull that procedure out of the global, eg, modifier -58 (staged or more extensive procedures),-78 (complications), or -79 (unrelated). If the procedure performed during a global period satisfies the criteria for a modifier, then charge the procedure with the modifier and you will be paid.

Uroflow is a procedure and would have to be performed for an unrelated problem to qualify for the -79 modifier. However, if the patient had a TURP and you wanted to check the flow rate, it would be inappropriate to charge for the uroflow with any modifier.

The bladder scan (51798) is unique. It is the only procedure in the 50000 section of the CPT book that has the designation “XXX” in the global category. That means global should not apply. Therefore you should be able to bill and be paid for that service during the global period of any other procedure without using a modifier.

Q

Would a urinalysis (dipstick method) be included in the evaluation and management of a patient? I am referring to cases when a physician does not send the dipstick to a laboratory.

A

First and foremost, no. A urinalysis-complete or dipstick only-should not be bundled into an E&M code. Medicare does not bundle the two. However, some private payers may bundle some or all urinalysis into the office visit. I recommend appealing all of those, and if the insurance company continues to deny, try to add language to the next contract that will assure payment in the future.

Q

Can you think of any circumstance where billing for fluoroscopic guidance (76000) during a stent placement (52332) would truly be indicated as a “separate” procedure? I work with a urologist performing a cystoscopy with bilateral retrograde ureteropyelograms with a left double-J stent placement and indicating the 76000 as well. The dictation is very clear, indicating that the fluoroscopy was used for guidance during the procedure. According to the Correct Coding Initiative edit, this is bundled. However, the indicator is a “1.” In my opinion, it should remain bundled and not billed as a separate procedure.

A

Unfortunately, under the current rules, I have to agree with you. The 76000 should not be charged in addition to the stent. If the fluoroscopic guidance was being performed for another problem or other parts of the anatomy, then you could charge for it separately using the appropriate modifier.

However, I cannot think of a single example in which you would use fluoroscopic guidance without another procedure or service that you should charge for. And, again, the fluoroscopic guidance would be bundled.

In the past, we were able to charge for fluoroscopic guidance in addition to the stent insertion or many other procedures. However, CMS made the decision that fluoroscopic guidance was a component part of the procedure and should not be paid separately. Fluoroscopic guidance was bundled into most endoscopy procedures. Therefore, it should not be charged separately.

Urologist Ray Painter, MD, is president of Physician Reimbursement Systems, Inc., in Denver and is also publisher of Urology Coding and Reimbursement Sourcebook

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.