Urology Billing & Codes

by | May 2, 2019 | Medical Billing

It’s very important that the proper codes are used in Urology billing, so that denials by insurance carriers can be minimized, and so that payments can be received promptly. Improper coding can cause significant delays in reimbursement, and can lead to claims being denied altogether, and that will have a serious impact on cash flow for your medical organization.

An experienced coding specialist can help in this regard, but to really ensure that your claims are being submitted with proper coding, it’s always a good idea to avail yourself of the services provided by medical billing companies, such as Medical Healthcare Solutions. Here is some background on the coding procedures which top-notch billing companies make use of daily, and which must be correctly used in order to ensure prompt reimbursement for medical services provided to patients.

CPT Codes

There are actually two different types of Current Procedural Terminology (CPT) codes which can be used, one which is used for Evaluation and Management (E&M), and the other being used for Procedures and Services rendered. Medicare recognizes these codes, along with a number of extensions or modifiers, which are added to the codes for the purpose of providing greater detail and clarifying the medical operation being performed. All E&M codes are included in the range of numbers between 99201 and 99499, and are used to describe patient visits such as visits to the office, consultations, or even hospital visits.

Procedures and Services are included in the range of codes from 50010 through 55899, which are used to identify urological procedures, and any of these codes which describe procedures can be billed to the insurance carrier. As with the E&M codes, there are also a number of modifier codes which further define the specific procedure which was performed, so that it clarifies exactly what was done. Insurance carriers are particularly on the lookout for these, since they tend to pinpoint the exact type of procedure which was carried out.

ICD-10-CM Coding System

This is the International Classification of Diseases, and it’s the 10th Revision in the series, with Clinical Modifications. This system of coding covers everything related to the diagnosis, conditions, symptoms, complaints, problems, or other reasons associated with the procedure which is being undertaken. These codes actually serve to justify the E&M codes and the Procedures and Services codes which are being used. It is allowable to use as many as four of these ICD codes on a Medicare claim form, with the first one which is listed considered to be the primary cause for the procedure.

When entering any of these codes, it is necessary to enter only one diagnosis on a line of detail for the claim you are making, and any additional diagnoses can be used to describe conditions which are co-existing at the time. It will also be necessary to enter the main reason for the procedure as well as any co-existing conditions into the medical record, so as to justify the claim. If any of the co-existing conditions require their own procedures or tests, these must also be entered on the claim form and in the medical record.

Makeup of ICD-10 Codes

All ICD-10 medical billing codes are composed of between three and seven characters, both numeric and alpha, and they classify groups of injuries or diseases according to the bodily organs they affect, and according to their etiology. Three digit codes may use four or five digit codes as sub-codes, but the billable codes will always be the ones which are at the highest level of specificity, so any code which lists a sub-code will be considered a category, rather than an actual billable code.

How Medical Healthcare Solutions can help

If your medical facility lacks the coding expertise to get medical claims processed quickly and efficiently, it will definitely be to your advantage to have all that handled for you, so that your practice can have a steady flow of incoming revenue. Medical Healthcare Solutions employs highly skilled and knowledgeable specialists who have all been thoroughly trained in the proper use of billing codes which insurance carriers expect to see on claim forms. With far less mistakes and much quicker handling of your medical billing codes, delays and denials will become a thing of the past for your company.

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