Ob-Gyn Coding Alert

While 2010 brings a record low number of coding changes, urogynecology coding, unfortunately, doesn't escape CPT's notice. In fact, your urodynamics coding -- and income -- will change drastically as of Jan. 1.

You will have three new urodynamics codes to learn starting Jan. 1. CPT 2010 adds the following codes:

• 51727 -- Complex cystometrogram (ie, calibrated electronic equipment); with urethral pressure profile studies (ie, urethral closure pressure profile), any technique.

• 51728 -- ... with voiding pressure studies (ie,bladder voiding pressure), any technique.

• 51729 -- ... with voiding pressure studies (ie, bladder voiding pressure) and urethral pressure profile studies (ie, urethral closure pressure profile), any technique.

To make room for these three new codes, the AMA deleted urodynamics codes 51772 (Urethral pressure profile studies [UPP] [urethral closure pressure profile], any technique) and 51795 (Voiding pressure studies; bladder voiding pressure, any technique).

"What they have done to reduce costs and payments is to combine several of the urodynamic codes into new sets of codes," says Michael A. Ferragamo, MD, FACS,clinical assistant professor of urology at the State University of New York in Stony Brook. That means your doctors cannot bill for each individual urodynamic procedure.

Keep an eye on +51797: The AMA deleted 51795 but left add-on code +51797 (Voiding pressure studies, intraabdominal [ie, rectal, gastric, intraperitoneal] [List separately in addition to code for primary procedure]), points out Alice Kater, CPC, PCS, coder for a private practice of South Bend, Ind. "I'm wondering if they will allow us to attach it to 51728 and 51729." A parenthetical reference after +51797 answers that very question. It states: "Use 51797 in conjunction with 51728, 51729."

Due to the planned readjus

You'll use the new "combination code" 51727 when your ob-gyn performs a complex cystometrogram and a urethral pressure profile (UPP), Ferragmo explains. And according to the clinical vignette submitted to the AMA with this code addition, the procedure will include a sustained Valsalva maneuver and several coughs.

New code 51728 is the new combination code for the CMG with a voiding pressure study, but new code 51729 is the "big change," Ferragamo says, because most obgyns perform a complete urodynamics workup which includes all three. This code includes the complex cystometrogram, the bladder voiding pressure, the UPP, and the Valsalva leak point pressure study, if performed additionally. Additionally, if your ob-gyn places a rectal catheter to determine if the patient is straining during the voiding event, you would then also bill the add-on code +51797 when billing either codes 51728 or 51729.

Old way: In the past, when your ob-gyn performed a complete urodynamic profile, you could report up to six separate codes based on the studies your ob-gyn performed:Ninety percent of the most commonly reported code combination for a female patient were 51726 Complex cystometrogram [e.g., calibrated electronic equipment]), 51772, 51795 and +51797, according to CMS. The physician might also tack on codes 51784 (Electromyography studies of anal or urethral sphincter, other than needle, any technique) or 51785 (Needle electromyography studies of anal or urethral sphincter, any technique). Note: You won't use 51741 (Complex uroflowmetry [e.g., calibrated electronic equipment]) because this is primarily for male patients, as this test measures urine stream flow.

For this reason, CMS decided to bundle the most frequent combinations. Because the physician doesn't repeat the pre and post work for each code, CMS considered them overvalued.

New way: Now you'll report primarily just three codes: 51729 for the complex cystometrogram, UPP, Valsalva leak point pressure, and bladder voiding pressure; 51784 or 51785 for the EMG; and +51797 for the rectal abdominal pressure.

Due to the planned readjustment to practice expenses, your reimbursement for urodynamic procedures will be lower -- in some cases, much lower, Ferragamo explains. "It was anticipated that [many physicians] were going to see a 17 percent drop in payments if everything had remained the same, now it looks like the reimbursement for urodynamics studies is going to be slashed in half from what they were last year."

Nonphysician practitioners (NPP) such as physician assistants (PA) can perform urodynamics studies and be paid for the service as long as you follow a few rules. The level of supervision your ob-gyn must provide for urodynamics studies depends on the type of study.

For most urodynamics procedures, the ob-gyn must provide direct supervision for a nurse, nurse practitioner (NP), medical technician, or PA. This means the ob-gyn must be present in the office when the NPP is performing the urodynamics.

Exception: As of Jan. 1, 2000, a PA may perform the technical component of diagnostic tests under general supervision as allowed under the law of the state in which the PA practices. An NPP may bill for the technical component with modifier TC (Technical component) and receive full reimbursement, and a physician may bill for the professional component with modifier 26 (Professional component).And if state law permits, an NP or clinical nurse specialist (CNS) may personally perform diagnostic tests without documentation of physician supervision.