Patient follow-up after urodynamic testing

Q Our nurse performs urodynamic testing in our office (CPT codes 51772, 51726-51, and 51741-51), which we bill globally, since our physician interprets the tests. Is the followup appointment (when the patient comes back for the test results, discussion of treatment options, etc.) a billable evaluation and management (E/M) visit or is it included in the urodynamics charge?

A All of the codes you cited have 0 global days, per the Medicare resource-based relative value scale, which means they include only services related to the urodynamic test on the day it is performed. If the patient returns to discuss results and treatment options, the visit is billed as an E/M service. In most cases, this visit will consist of counseling. You therefore could meet the CPT requirement that says if counseling dominates the encounter, you can pick your E/M service based on the typical time detailed in the code description. Just be sure the physician indicates the content of the counseling and the time it took, so that the correct level of E/M service can be selected.

This article was written by Melanie Witt, RN, CPC, MA, former program manager in the Department of Coding and Nomenclature at ACOG. She is now an independent coding and documentation consultant. Her comments reflect the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.

Q Our nurse performs urodynamic testing in our office (CPT codes 51772, 51726-51, and 51741-51), which we bill globally, since our physician interprets the tests. Is the followup appointment (when the patient comes back for the test results, discussion of treatment options, etc.) a billable evaluation and management (E/M) visit or is it included in the urodynamics charge?

A All of the codes you cited have 0 global days, per the Medicare resource-based relative value scale, which means they include only services related to the urodynamic test on the day it is performed. If the patient returns to discuss results and treatment options, the visit is billed as an E/M service. In most cases, this visit will consist of counseling. You therefore could meet the CPT requirement that says if counseling dominates the encounter, you can pick your E/M service based on the typical time detailed in the code description. Just be sure the physician indicates the content of the counseling and the time it took, so that the correct level of E/M service can be selected.

This article was written by Melanie Witt, RN, CPC, MA, former program manager in the Department of Coding and Nomenclature at ACOG. She is now an independent coding and documentation consultant. Her comments reflect the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.

Q Our nurse performs urodynamic testing in our office (CPT codes 51772, 51726-51, and 51741-51), which we bill globally, since our physician interprets the tests. Is the followup appointment (when the patient comes back for the test results, discussion of treatment options, etc.) a billable evaluation and management (E/M) visit or is it included in the urodynamics charge?

A All of the codes you cited have 0 global days, per the Medicare resource-based relative value scale, which means they include only services related to the urodynamic test on the day it is performed. If the patient returns to discuss results and treatment options, the visit is billed as an E/M service. In most cases, this visit will consist of counseling. You therefore could meet the CPT requirement that says if counseling dominates the encounter, you can pick your E/M service based on the typical time detailed in the code description. Just be sure the physician indicates the content of the counseling and the time it took, so that the correct level of E/M service can be selected.

This article was written by Melanie Witt, RN, CPC, MA, former program manager in the Department of Coding and Nomenclature at ACOG. She is now an independent coding and documentation consultant. Her comments reflect the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.