Urology Coding Alert

Know the Flow of Urodynamic Test Coding

Dodge claim errors by spotting the differences between these tests.

When a urologist conducts urodynamic testing, they are assessing the performance and efficiency of the patient’s bladder, sphincters, and urethra. Most tests only focus on how well your bladder can store and empty urine.

To accurately identify the code to report the tests your urologist might order during urodynamics, you must always check the medical documentation to see if your urologist performed a simple or a complex test. Normally, simple tests use manual equipment such as spinal manometry or stop watch flow rate, while complex testing uses calibrated electronic equipment. You should always double-check if they performed additional testing along with the urodynamics.

It can be perplexing to code these tests, as a single code might not provide enough specificity. To ensure the submission of error-free urodynamics testing claims in your urology practice, take a look at these four frequently asked questions.

Question 1: What Happens During Urodynamic Testing?

Urodynamic studies are investigative procedures used to assess a patient’s bladder function and determine what might be causing them problems. At an initial urodynamic study, your urologist will use cystometry to measure the patient’s bladder capacity and bladder pressures during filling and emptying of the bladder. The actual test is called a cystometrogram (CMG).

During urodynamic testing, your urologist will insert a catheter into the patient’s bladder through the urethra, and it is necessary for the bladder to be filled with water. The catheter is usually attached to electronic equipment that includes a computer program that calculates the fluid in the bladder to test for the following conditions:

• Frequent urination
• Inability to hold urine
• Involuntary loss of urine
• Slow urination
• Incomplete bladder emptying

Know the Cs of bladder filling and emptying: The characteristics or symptoms they are looking for all begin with the letter C. In the filling phase, the “Cs” consist of contractions (involuntary), compliance, continence, capacity, and coarse sensation. In the emptying phase, the urologist is looking for contractility, complete emptying, coordination, and clinical obstruction (if any).

According to the Centers for Medicare & Medicaid Services (CMS) policy for urodynamics testing, the patient’s medical record must include:

• The urologist’s assessment as it relates to the complaint at that visit
• A relevant medical history
• The results of any tests or procedures that have already been performed and are pertinent to the complaint
• Signed and dated office visit notes or procedure reports
• Demonstration of why the testing was medically necessary

Question 2: Which CPT^® Codes Are Used for Urodynamics?

CPT^® gives you multiple codes to choose from when reporting a CMG and urodynamic studies. Knowing the differences between the tests is your key to proper code choice. When your urologist performs urodynamics tests, you must dig deeper into the documentation for clues about which code to report. Your code choices are as follows:

• 51725 (Simple cystometrogram (CMG) (eg, spinal manometer)). A simple CMG uses a spinal manometer to determine bladder pressures and is rarely performed as a single procedure.
• 51726 (Complex cystometrogram (ie, calibrated electronic equipment)) . This service is a complex CMG where a urologist will fill the patient’s bladder through a catheter and measure the pressures with complex CMG-calibrated electronic equipment.
• 51727 (… with urethral pressure profile studies (ie, urethral closure pressure profile), any technique). If your provider also performs a complex CMG, fills the patient’s bladder through a catheter, measures the pressures with complex CMG-calibrated electronic equipment, and performs a urethral pressure profile (UPP), you should report this code. You should also bill 51727 for a complex CMG and a Valsalva leak point pressure (VLPP) in place of a UPP.
• 51728 (... with voiding pressure studies (ie, bladder voiding pressure), any technique). When your urologist performs a complex CMG with voiding pressure studies using any technique, you should report this code.
• 51729 (... with voiding pressure studies (ie, bladder voiding pressure) and urethral pressure profile studies (ie, urethral closure pressure profile), any technique). When your urologist performs a complex CMG with voiding pressure studies and UPP using any technique or VLPP, you should report 51729.

Question 3: What if the Urologist Performs Additional Studies or Testing?

When your urologist performs a urodynamic study, they will usually perform complex uroflowmetry, which tells your urologist the actual flow of urine upon voiding and whether the flow is free or obstructed. You should report uroflowmetry with code 51741 (Complex uroflowmetry (eg, calibrated electronic equipment)).

During a complete urodynamic study, your urologist may also perform an electromyography (EMG) with a bladder voiding pressure (VP) study. You may report one or more of the following codes for these studies, if your urologist performs them:

• 51784 (Electromyography studies (EMG) of anal or urethral sphincter, other than needle, any technique) or 51785 (Needle electromyography studies (EMG) of anal or urethral sphincter, any technique)
• +51797 (Voiding pressure studies, intra-abdominal (ie, rectal, gastric, intraperitoneal) (List separately in addition to code for primary procedure)). Note: You can only report add-on code +51797 in conjunction with codes 51728 and 51729. Add-on codes do not require modifier 51 (Multiple procedures), and keep in mind that their fees are not reduced when billed.
• 51798 (Measurement of post-voiding residual urine and/or bladder capacity by ultrasound, non-imaging)

If your urologist performs a radiological voiding study in addition to a complex urodynamics study, you may also report the following codes on your claim:

• 51600 (Injection procedure for cystography or voiding urethrocystography)
• 74455 (Urethrocystography, voiding, radiological supervision and interpretation)

Question 4: How Should I Code Video Urodynamic Tests?

Video urodynamic tests combine cystometry, uroflowmetry, and X-ray cystography into a few tests. The digital equipment used can measure urine flow and pressure in the bladder or rectum by using X-rays. This equipment takes images of the bladder during filling and emptying. According to Stephanie Storck, CPC, CPMA, CUC, CCS-P, ACS-UR, longtime urology coding expert and consultant in Glen Burnie, Maryland, “The X-rays and videos show the size and shape of the bladder, which helps the provider identify the possible problems in the urinary tract to improve diagnostic accuracy for a patient whose condition is difficult to identify.”

If your urologist adds a video portion to the urodynamic study, be sure to code:

• 51600 (Injection procedure for cystography or voiding urethrocystography) for the instillation into the bladder of the contrast material
• 74455 for the voiding cystourethrogram or 74430 (Cystography, minimum of 3 views, radiological supervision and interpretation) for a static cystogram.