Urology billing, handled with care
Where urology billing gets difficult
The issues we see most often, and the ones that quietly cost practices the most.
In-office procedure details
Procedures done in the clinic may allow different payment and supply billing than the same services in a facility.
Global periods after procedures
Follow-up care after urologic procedures can be included in the original payment, depending on the procedure’s global period.
In-house testing
Urodynamics, ultrasound and lab testing may have component billing and supervision rules.
Injectable drugs
Office-administered drugs for conditions such as prostate cancer require accurate units, NDC reporting and authorization.
How we handle them
Setting-based billing
We confirm where each procedure took place and apply the right place of service and supply rules.
Global window tracking
Procedures are tracked so visits during the global period are coded appropriately or not billed when included.
Testing component review
We check ownership and interpretation details for in-office testing before billing global or split components.
Drug billing accuracy
Drug units, NDCs and authorizations are checked against the administration record for each dose.
Coding notes
General guidance only. Code sets update every year and payer policies vary, so we check current rules on every claim.
- Cystoscopy and office procedures
- Diagnostic cystoscopy (52000) generally carries a 0-day global period. Many other urologic procedures carry 10 or 90-day globals, which affect billing for follow-up visits.
- Urodynamics components
- Many urodynamic study codes can be split into professional and technical components with modifiers 26 and TC, depending on who owns the equipment and who interprets.
- Drugs and units
- Office-administered drugs are billed with HCPCS codes, with units based on the code descriptor. Many payers also require the NDC on the claim.
Urology billing questions
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