Urology Coding Alert

Learn what makes a urodynamics test 'complex' and when you should report a higher-paying code

When a urologist performs a urodynamics study, he usually performs a simple or complex cystometrogram (CMG), a simple or complex uroflowmetry (UFR), and leakpoint pressure tests. The testing might also involve other studies, such as electromyography (EMG) studies, stimulus evoked response, voiding pressure (VP), and rectal pressure studies.

Simple vs. complex CMG: For a simple CMG, which involves the urologist placing a small catheter in the bladder, filling the bladder by gravity and measuring capacity and storage pressures using a spinal manometer, you'll report code CPT 51725 (Simple cystometrogram [e.g., spinal manometer]).
 
If your physician performs a complex CMG in which  he fills the bladder through a catheter and measures the pressure with calibrated electronic equipment, you'll report 51726 (Complex cystometrogram [e.g., calibrated electronic equipment]) instead.

Simple vs. complex UFR: When the urologist observes a patient's urine flow, using a stopwatch to assess the flow, you should report 51736 (Simple uroflowmetry [e.g., stopwatch flow rate, mechanical uroflowmeter]) for a simple UFR.
 
On the other hand, if the physician uses electronic equipment to measure the flow, you'll report code 51741 (Complex uroflowmetry [e.g., calibrated electronic equipment]).

EMG studies: Another type of urodynamics study your urologist may perform is an EMG study in which he places patch electrodes around the urethral sphincter to measure electrical and muscular activity of the perineal muscles and the urinary sphincter.
 
You'll report 51784 (Electromyography studies of anal or urethral sphincter, other than needle, any technique) for this test. If your urologist does a needle EMG during which he places needles into the pelvic floor to measure muscle activity during bladder filling and at rest, you should instead report 51785 (Needle electromyography studies of anal or urethral sphincter, any technique).

Stimulus evoked response: During this study, the urologist stimulates the sacral arch by stimulating the glans or clitoris and measuring motor activity in the pelvic floor or urethral sphincter.
 
You'll use code 51792 (Stimulus evoked response [e.g., measurement of bulbocavernosus reflex latency time]) for this study. Today, urologists rarely perform this study during urodynamics studies because it provides little useful clinical information on the status of bladder function.

VP studies: When the physician measures pressure during voiding, you should choose a code based on whether he measures the VP just in the bladder (51795, Voiding pressure studies; bladder voiding pressure, any technique) or in the bladder and abdomen simultaneously (51797, ... intra-abdominal voiding pressure [AP] [rectal, gastric, intraperitoneal]).

Valsalva (abdominal) leak point pressure: The urologist asks the patient to bear down forcefully (Valsalva maneuver) while he observes the abdominal pressure at which leakage occurs from the bladder (around the catheter) when the bladder has been filled with a minimum of 150 cc of fluid. 
 
The bladder pressure at leakage is called the leak point pressure.
 
As suggested by the American Urological Association, report 51772 (Urethral pressure profile studies [UPP] [urethral closure pressure profile], any technique) for this study whether it be "positive, leakage demonstrated," or "negative, no leakage seen."