Urology Coding Alert

You stand to lose 50 percent of your urodynamics reimbursement -- here's why.

Urodynamics coding and reimbursement has long been a challenge for urology coders -- and your job gets even harder on Jan. 1.

While CPT Codes 2010 brings a record low number of coding changes, urology coding, unfortunately, doesn't escape changes. In fact, your urodynamics coding -- and income -- will change drastically after the first of the year.

Get to Know 3 New Complex Cystometrogram Codes

You will have three new urodynamics codes to use starting January 1. "To reduce costs and payments, CPT combined several of the urodynamic codes into one of several new codes," says Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology at the State University of New York in Stony Brook. "So doctors will not be able to bill each individual urodynamic procedure as they have in the past."

"They are taking two to three codes usually billed for as separate services in urodynamics and combining them into one code," confirms Paul Arnold, MD, of Bay Urology in Safety Harbor, Fla. The AMA deleted urodynamics codes 51772 (Urethral pressure profile studies [UPP] [urethral closure pressure profile], any technique) and 51795 (Voiding pressure studies; bladder voiding pressure, any technique). CPT 2010 adds the following codes:

• 51727 -- Complex cystometrogram (i.e., calibrated electronic equipment); with urethral pressure profile studies (i.e., urethral closure pressure profile), any technique

• 51728 -- ... with voiding pressure studies (i.e., bladder voiding pressure), any technique

• 51729 -- ... with voiding pressure studies (i.e., bladder voiding pressure) and urethral pressure profile studies (i.e., urethral closure pressure profile), any technique.

If your urologist also performs a urethral pressure profile (UPP), report 51727 (Complex cystometrogram [ie, calibrated electronic equipment]; with urethral pressure profile studies [i.e., urethral closure pressure profile], any technique). For a complex CMG with voiding pressure study, report 51728 (... with voiding pressure studies [i.e., bladder voiding pressure], any technique). For a complex CMG with voiding pressure study and UPP, use 51729 (... with voiding pressure studies [i.e., bladder voiding pressure] and urethral pressure profile studies [i.e., urethral closure pressure profile], any technique).

Keep an Eye on +51797

Possible pitfall: The AMA deleted 51795 but left addon code +51797 (Voiding pressure studies, intraabdominal [i.e,, rectal, gastric, intraperitoneal] [List separately in addition to code for primary procedure]), points out Alice Kater, CPC, PCS, coder for Urology Associates of South Bend, Ind. Kater asks: Will CPT allow coders to attach +51797 to 51728 and 51729? The answer to that question appears after +51797 in a parenthetical reference: "Use 51797 in conjunction with 51728, 51729."

Switch From 6 Codes to Just 4

You'll use the new "combination code" 51727 when your urologist performs a complex cystometrogram and a urethral pressure profile (UPP), or a Valsalva leak point pressure (VLPP), Ferragamo explains.

New code 51729 is the "big change," Ferragamo says, because most urologists do perform a complete urodynamics workup. This code includes the complex cystometrogram, the bladder voiding pressure, and the UPP or VLPP study.

Old way: In the past, when your urologist performed a complete urodynamic profile, you could report up to six separate codes based on the studies your urologist performed: 51726, 51741, 51784, 51795, 51797, and 51772. Payers would have individually reimbursed you for the full complement of the codes, Ferragamo says.

New way: Now, you'll report just four codes for complete urodynamic profiles:

• 51729 for the complex cystometrogram, UPP or VLPP, and bladder voiding pressure

• 51741 (Complex uroflowmetry [e.g., calibrated electronic equipment]) for the complex uroflow

• 51784 (Electromyography studies of anal or urethral sphincter, other than needle, any technique) for the EMG

• +51797 (Voiding pressure studies; intra-abdominal voiding pressure [AP] [rectal, gastric, intraperitoneal]) for the rectal (abdominal) pressure.

Calculate How the Changes Affect Your Payments

When payers recalculate 51741, 51784, and +51797, those codes' reimbursement is likely to decrease. Experts are predicting that CMS will reduce the practice expense portion of the urodynamics codes' reimbursement.

Most likely, the reimbursement will be "substantially less" than when you were able to report six codes billed separately, Arnold laments. "Therefore, urodynamics will be less profitable, since the costs of the equipment and disposables will continue to increase." Experts anticipated that urologists would have seen "a 17 percent drop in payments if urodynamic coding had remained the same; now it looks like the reimbursement for urodynamics studies will be slashed in half from what they were last year," Ferragamo adds. "That's a huge loss for urology practices."

"I will be very interested to check the relative value units (RVUs) against those of the codes they are replacing," Kater says. "I bet dollars to donuts the new RVUs are substantially reduced and would be surprised if they are not."

Stay tuned: Look for more information about your 2010 reimbursement rates and the finalized Medicare Physician Fee Schedule in the next issue of Urology Coding Alert.