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UCR 163: FAQs - Hiring Certified Coders; Removal of foley, nurse visit or bladder irrigation? "Modifier Required"; Assistant Surgeon - preop / interop consult?

September 22, 2023 

Ray, Mark, and Scott discuss questions that came into the Urology Coding and Reimbursement Group:

1. We are looking to hire a certified coder. We are open to the position being remote if the candidate has urology experience. If you know anyone interested, please send them my way. Also, feel free to email me your resume or if you have any questions.
2. Patient has a nurse visit for removal of a foley catheter that was placed during a procedure with a 00-day global (i.e TURBT). Visit was 2 days after surgery. Documentation by nurse states; Pt in for foley cath removal. 10 ml sterile water removed from balloon, balloon deflated, foley cath removed. Pt tolerated well. Should we be billing a 99211 nurse visit, a 51700 for bladder irrigation or considered part of the surgical package and would not be billable?
3.  My question is what if I use a modifier that Coding Today indicates a modifier is required, and the insurance company still denies the second procedure with the modifer as included in the primary procedure, such as CPT's 52332 and 52005-59. Is this appealable?

4. To clarify the Assistant Surgeon, is this is completely separate from a pre op consult to place stents for ureteral identification or an intraop consult for cystoacopy or foley placement or to repair a bladder injury?

Mark Painter and PRS Consulting

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