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Urology Coding Alert

Code All Aspects of Urodynamics Studies for Steady Stream of Reimbursement

Published on Wed May 25, 2005

Bring in over $900 per session with the answers to these frequently asked questions

Whether your practice performs urodynamics tests in the office or interprets the results of tests performed at a hospital, there's plenty of room for coding confusion. Read on for some frequently asked questions - and expert answers - about these common, yet often vexing, tests.

Q: What's the difference between the different urodynamics codes?

A: Typically, urodynamics studies consist of a simple or complex cystometrogram (CMG), a simple or complex uroflowmetry (UFR), and leakpoint pressure tests. The urologist may also perform electromyography (EMG) studies, stimulus evoked response, or voiding pressure (VP) studies.
 

  •  In a simple CMG (51725, Simple cystometrogram [e.g., spinal manometer]), the urologist places a small catheter in the bladder, filling the bladder by gravity and measuring capacity and storage pressures using a spinal manometer.
     
  •  A complex CMG (51726, Complex cystometrogram [e.g., calibrated electronic equipment]) involves filling the bladder through a catheter and measuring the pressure with calibrated electronic equipment.
     
  •  During a simple UFR (51736, Simple uroflowmetry [e.g., stopwatch flow rate, mechanical uroflowmeter]), the urologist visually observes the flow of urine, sometimes using a stopwatch to gauge the flow.
     
  •  A complex UFR (51741, Complex uroflowmetry [e.g., calibrated electronic equipment]) makes use of special electronic equipment to measure the flow of urine.
     
  •  EMG studies (51784, Electromyography studies of anal or urethral sphincter, other than needle, any technique), in which the urologist places patch electrodes around the urethral sphincter to measure electrical and muscular activity of the perineal muscles and urinary sphincter, usually occur alongside a complex CMG (51726) or a VP study.
     
  •  A needle EMG (51785, Needle electromyography studies of anal or urethral sphincter, any technique) involves placing needles into the pelvic floor to measure muscle activity during bladder filling and at rest. Needle EMGs may be performed with other urodynamic studies.
  •  Stimulus evoked response (51792, Stimulus evoked response [e.g., measurement of bulbocavernosus reflex latency time]) involves stimulating the sacral arch by stimulating the glans or clitoris and measuring motor activity in the pelvic floor or urethral sphincter. Urologists usually perform this test separately from other urodynamics tests.
     
  •  VP studies (51795, Voiding pressure studies; bladder voiding pressure, any technique; and 51797, ... intra-abdominal voiding pressure [AP] [rectal, gastric, intraperitoneal]) measure pressure during voiding, either just in the bladder (51795 ) or in the bladder and abdomen simultaneously (51797). Subtracting the voiding abdominal pressure from the total bladder pressure on voiding gives the most accurate determination of true voiding pressure, also known as detrusor pressure, says Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology at the State University of New York in Stony Brook.

    Q: How should I code for video urodynamics?

    A: Report the codes that reflect the contrast agent injection and the reading of the video films as well as the urodynamic components.

    If your office performs urodynamic studies with video films requiring a contrast agent and fluoroscopy, report 51600 (Injection procedure for cystography or voiding urethrocystography) for the instillation of contrast into the bladder, and 74455 (Urethrocystography, voiding, radiological supervision and interpretation) for the interpretation of the radiological studies, along with the appropriate urodynamics codes, says Heather Smolinski, CPC, coding specialist with Genito-Urinary Surgeons in Toledo, Ohio.
     
    Disaster averted: Avoid the temptation to code separately for the fluoroscopy. CPT code 76000 (Fluoroscopy [separate procedure], up to one hour physician time, other than 71023 or 71034 [e.g., cardiac fluoroscopy]) is bundled into 74455 and is not separately reportable, Smolinski says.

    Q: Do I need to append modifiers to the CPT codes when we perform multiple urodynamics studies on the same day?

    A: The urodynamics codes are generally free from National Correct Coding Initiative (NCCI) bundles, meaning that you should be able to report them separately when they are performed separately, without appending a modifier to break the bundle. Some carriers may require modifier -51 (Multiple procedures) appended to each code listed after the first one.

    Medicare will automatically append modifier -51 to the appropriate codes, so do not append modifier -51 when coding for Medicare carriers.

    Exception: NCCI does include 51725 (simple CMG) as a component of 51726 (complex CMG), and a modifier indicator of "0" forbids you from reporting the two codes together, even with a modifier.

    Carriers will usually reduce reimbursement for each procedure listed after the first one, so report the highest-reimbursing CPT code - the one with the highest number of relative value units (RVUs) assigned to it - first.

    Example: You might code a typical videourodynamics session as follows, based on the unadjusted non-facility RVUs in Medicare's 2005 Physician Fee Schedule:

    Line 1: 51726 (complex CMG), 9.39 RVUs

    Line 2: 51741-51 (complex UFR), 2.04 RVUs

    Line 3: 51784-51 (EMG), 5.67 RVUs

    Line 4: 51795-51 (bladder VP), 9.04 RVUs

    Line 5: 51797-51 (rectal pressure), 7.55 RVUs

    Line 6: 51600-51 (injection with contrast), 5.99 RVUs

    Line 7: 74455-51 (interpretation of voiding cystourethrogram), 2.14 RVUs.

    Q: Private carriers keep denying our claims for 51795 and 51797 when they are coded together. I feel that we should be getting paid separately for these. What's the problem?

    A: The AMA agrees: If the urologist performs 51795 and 51797, you should report both and carriers should pay for both, said the agency in the December 2001 CPT Assistant. When appealing denials, try citing that reference. And the American Urological Association (AUA) notes that 51797 is a complementary test to 51726 (which measures only bladder storage), and carriers should not bundle 51797 into 51726. "If the urologist makes separate measurements for these studies, he should receive payment for each," Ferragamo says. 

    Helpful: The AUA provides a letter explaining urodynamics procedures to carriers. To download this letter, which has thorough explanations of all the different tests, visit     http://www.auanet.org/coding/reimburse/appeal/urodynamics.pdf.

    Q: Our CMG testing is done at the hospital with the tracing sent to our physicians. Can my physicians charge to read the CMG?

    A: Yes. If all the urologist is doing is interpreting a test performed in another facility (or on equipment that the urologist does not own), he is performing only the professional component of that service. Add modifier -26 (Professional component) to all urodynamics codes when performed in a hospital or any other facility outside of the office, such as a nursing home, and receive payment for only the professional component, says Kerri Bailey, CPC, coder and lead biller for the Urology Center of Columbus, Ga.
     
    Don't overlook: Even if your practice owns the equipment and brings it to a hospital or nursing home, continue to code all components with modifier -26. The facility should code for the technical component, and the urologist should seek compensation for his equipment from the facility. The urologist works that out with the hospital where he works.

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