Ob-Gyn Coding Alert

Question: We do urodynamic testing to determine the diagnosis for our patients, and whenever we submit our billing for this test, our payers ask us to submit the notes for these procedures. When we do the testing, the most common codes we use are 51726, 51784, 51795, 51797, 51772, and 51741. The payer reps say we should add modifier 51 to these codes. I was recently told that the reason for the audit of notes is because we use the 51741 as the fifth or sixth code and any time five or more "surgical" codes are submitted, the claim requires a review of notes. Should we use modifier 26 instead of 51? What is the best way to code these procedures?

Connecticut Subscriber

Answer: Unfortunately, you'll find no standard for urodynamic testing as 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 see if you can get an exception to billing several of these diagnostic, non-surgical procedures.

As for modifiers, you should use only 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 these codes are listed in the surgical section of your CPT book, you may need to use modifier 51 (Multiple procedures). Apply this modifier to all the codes except for the code listed first. Check with your payer as to its preference.

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