Urology Coding Alert

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 [...]