Ob-Gyn Coding Alert

Question: Whenever we submit our billing for urodynamic testing, our payers ask us to submit the notes for these procedures. The payers say we should add modifier 51 to 51726, 51784, 51795, 51797, 51772 and 51741. I was recently told that the reason for the audit of notes is that we use 51741 as the fifth or sixth code. Should we be using modifier 26 instead of 51? What is the best way to code these procedures?


Massachusetts Subscriber

Answer: Unfortunately, you-ll find no standard for urodynamic testing because individual payers determine how you should submit these claims. The best advice is to check your payers- specific policies for urodynamic coding and then start a dialog between your provider and the medical director of the plan to get an exception to billing several of these diagnostic, non-surgical procedures.

As for modifiers, you should only use modifier 26 (Professional component) if your ob-gyn did not use your practice's own equipment. The codes you mentioned (such as 51726, Complex cystometrogram [e.g., calibrated electronic equipment]) have both a technical and professional component, so you will need to be clear with the payer whether you are billing for both components (in which case, you would not use modifier 26) or only the professional component (in which case, you would).

Because CPT lists these codes in the surgical section of the CPT book, you may need to use modifier 51 (Multiple procedures). Apply this modifier to all of the codes except for the code listed first. Ask your payer for  its preference.

Heads up: You-ll also find that most payers will always want to review your ob-gyn's documentation when he performs more than three or four procedures on the same date, so be prepared to include it.