Urology Coding Alert

You're not alone if you've been receiving denials for billing fluoroscopy with your physician's last interpretation of a retrograde pyelogram.

Coders across the nation are receiving denials for billing fluoroscopy, 76000 (Fluoroscopy [separate procedure], up to one hour physician time, other than 71023 or 71034 [e.g., cardiac fluoroscopy]), when billed with radiological readings thanks to a recent NCCI edit in version 9.0. CPT code 76000 was bundled into many radiological readings, including those reading codes most often encountered by urologists such as a retrograde pyelogram, CPT 74420, says Karen Delebreau, coding specialist with Urological Surgeons in Green Bay, Wis. IVP, cystogram, injection urethrogram and voiding cystogram readings are also among the bundled. You should no longer bill fluoroscopy, 76000, in addition to these radiological readings.

There's been another change to proper coding, says Michael A. Ferragamo, MD, FACS, clinical assistant professor at State University of New York, Stony Brook. The new 2003 CPTcode 51798 (Measurement of post-voiding residual urine and/or bladder capacity by ultrasound, non-imaging) should only be used with simple, hand-operated sonographic equipment that gives the volume of residual urine but does not provide an image.

For those practices using the standard ultrasonic machine to calculate the volume of residual urine from imaging, you should report 76775 (Ultrasound, retroperi-toneal [e.g., renal, aorta, nodes], B-scan and/or real time with image documentation; limited) instead of 51798. And talk about a difference in reimbursement 51798 pays an average of $19.02 while the combined professional component and technical component of 76775 pays an average of $80.21, according to the 2003 nonadjusted Medicare Physician Fee Schedule.

Expect parameters placed on the allowed frequency of reporting 76775 as well as the diagnosis codes that will be accepted for 76775. Urology Coding Alert will keep you posted when CMS supplies further information.