Consider these points when billing for 'shared' appointments

September 1, 2005

Q I read the article about "group shared appointments" in the Aug. 1, 2005, issue of Urology Times. Are there specific billing, coding, and documentation issues associated with this type of appointment?

Q I read the article about "group shared appointments" in the Aug. 1, 2005, issue of Urology Times. Are there specific billing, coding, and documentation issues associated with this type of appointment?

The group shared appointment (GSA) is no exception. I think the authors of the article covered the key issues fairly well. As they indicated, you definitely could not charge for such an appointment based on time. Each patient should be evaluated and treated individually. Documentation must accurately record each en-counter, and billing should accurately reflect that individual encounter.

I am not aware of specific coding rules that prevent billing for services for patients participating in a GSA as outlined in the article. However, the payment system was designed for individual patient encounters, and this would appear to circumvent that intent.

If GSAs become prevalent, I would not be surprised to see a specific code or modifier that must be applied. Group therapy has been recognized and given specific codes in certain circumstances, and payment for these services has been adjusted accordingly.

Q I perform transrectal ultrasound-guided prostatic biopsy in the hospital as an outpatient procedure (in a minor treatment room), utilizing the ultrasound machine and tech of the hospital to set up the machine and to size the prostate. I perform the TRUS and biopsy. In my operative report, I do mention my findings on the TRUS. How do I code these procedures to maximize reimbursement?

A If you performed a diagnostic ultrasound and properly documented your findings, then conducted an ultrasound-guided biopsy and documented both of those procedures, then you should charge for the diagnostic ultrasound, ultrasound guidance, and needle biopsy. However, since you are using the hospital equipment, space, and technician, then you would add a modifier –26 to the ultrasound procedures. You will charge for the professional component (–26), and the hospital will charge for the technical component, as follows:

Good news! Aetna has agreed to reverse its previous policy and pay for both the ultrasound guidance and the diagnostic ultrasound. If you have been denied payment by Aetna for those services, between Nov. 16, 2004, and May 14, 2005, you should resubmit the claim for payment. If you have been denied payment after May 14, 2005, you should appeal.

Q I need coding clarification on the following scenario: cystourethroscopy, left retrograde pyelogram, and placement of the left ureter. What are the appropriate codes for the CPT/HCPCS, radiology, surgery, and the device?

A I would need more specific information to properly answer your question. I will assume two scenarios and will give the proper coding for each one.

In the first scenario, the patient was scheduled for a left diagnostic retrograde, possible left ureteroscopy with lithotripsy. The left retrograde revealed an upper ureteral calculus, and the decision was made to do a ureteroscopy with lithotripsy. This was performed without difficulty. A double-J indwelling stent was inserted. Assuming all procedures were properly documented, including a separate dictation for the reading of the left retrograde, the procedures should be billed as follows: