Untangling the Rules for 2018: Coding Multiple CPT Procedures in UrologyKey Questions to Consider When Submitting Claims
Each day, urologists perform increasingly complicated operations involving multiple surgical procedures and different CPT® codes. Such complex procedures can trip up even the most seasoned coder, especially when several of the procedures performed are surgically unrelated and can’t be bundled.
As part of the Virtual Boot Camp with AudioEducator, urology specialist Dr. Michael A. Ferragamo provides algorithms to demonstrate how to correctly code multiple procedures performed at the same time. In the presentation, Ferragamo also discusses the special rules for coding multiple procedures at the same encounter, as well as how to use modifiers -50, -51, -62, -80. and -82 to ensure accurate claims.
Understanding the Clinical Scenario
Receiving a physician’s report that lists multiple procedures can be overwhelming. When determining the clinical scenario, it’s important to ask a few key questions:
- What is/are the component/s of the procedure?
- Are there separate procedures?
- Are there separate encounters or incisions?
- Are the procedures different? Do they overlap?
- Are the procedures bilateral?
Once you’ve answered those questions, you’ll need to know if the urologist was acting as a surgeon, assistant surgeon, co-surgeon, or both as an intra-operative consultant and a surgeon.
The next step will be to figure out how to code for multiple procedures—though how you do that will depend on whether the procedures involved one or two surgeons. Read on.
1 Surgeon, Multiple Procedures
In order to count as multiple surgeries, the procedures must:
- Have been performed by one physician or multiple physicians in the same practice;
- Have been performed on the same patient; and
- Have been performed either during the same operative session or on the same day.
To determine how to code the procedures, look at the following:
- Does one CPT® code cover all procedures performed? If so, only one CPT® code can be reported.
- If one CPT® code does not cover all procedures performed, ask: Can the procedures be bundled? If not, charge for multiple procedures, using modifier -51 as necessary.
- If two CPT® codes are applicable and the procedures can be bundled, ask: Are the procedures integral? If not, charge for each separately, using modifiers -59, -XS or -XU as appropriate. If they are integral, charge only for the main procedure as one procedure would be considered an integral component of the other (for reimbursement procedures).
2 Surgeons, Multiple Procedures
When two surgeons perform multiple procedures, they may act in the following ways:
- One surgeon as primary and the other as assistant
- Both as primary or co-surgeons
- Each surgeon performing separate, non-bundled procedures
- Each surgeon performing a separate bundled procedure
After determining the role of each surgeon in the procedures, determine the following for proper coding:
- Does one CPT® code cover the procedures performed? If yes, you have the option of charging the surgeons as primary and assistant and using modifiers -80 or -82 as appropriate. Your other option is to use modifier -62 (charging each as co-surgeons).
- If it’s necessary to use more than one CPT® code, ask: Can the codes be bundled? If not, each surgeon would charge for their own procedure, with no modifiers used.
- If the procedures can be bundled, ask: Are the procedures integral? If not, each surgeon would also charge for their own procedure with no modifiers used. If the procedures are integral, you again have two options: Either you can charge the surgeons as primary and assistant, or you can charge as co-surgeons, with using modifier -62.
Putting the Pieces Together
The rules for coding multiple procedures are definitely complex, with Medicare having its own definitions of the circumstances in which modifiers like -62, -80, and -82 can be used. But don’t lose heart. Although the rules appear complex, by repeating the information a few times you’ll have the solid knowledge your practice needs for successful reimbursement. Ferragamo’s presentation as offered through AudioEducator offers a wealth of information you can review as many times as you need, at your own convenience, to strengthen the coding knowledge your practice needs.