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    Is billing for stone prevention counseling possible?

    Documentation must show an underlying condition requiring an added course of treatment

    Ray Painter, MDRay Painter, MD Mark PainterMark Painter

    I have a patient that had an extracorporeal shock wave lithotripsy (90-day global), and the physician saw the patient within the 90 days to counsel the patient on how to prevent future stones. The physician wants to bill an evaluation and management. Can this be done?

    This is a great question and one we have discussed frequently over the years. The answer is maybe.

    READ: Modifiers for multiple stones raise questions

    As we have discussed the issue among ourselves and with others, we have been forced to conclude at this point that you should not charge for stone prevention during the global period of a service provided to treat stones for the routine patient. However, for those patients who truly have an underlying condition diagnosed by the physician that will more than likely cause additional stones and will require more medical management and provider effort than the average stone patient, you should consider reporting the visit.

    To arrive at a more detailed and targeted answer, you have to ask yourself several questions. Was the discussion of a routine nature that is needed with most stone patients? What was the medical necessity for having that discussion with this patient? Was the discussion related to stone prevention, or was it for the treatment of a disease process? Was there significant, extra work performed over and above the routine follow-up for the surgery?

    NEXT: Looking at the definition of modifier –24

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    Ray Painter, MD
    Urologist Ray Painter, MD, is president of Physician Reimbursement Systems, Inc., in Denver, and is also publisher of Urology Coding and ...
    Mark Painter
    Mark Painter is CEO of PRS Urology SC in Denver.


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