Urology Coding Alert

Tying the test supplies purchased by practices to arguments for medical necessity and specific ICD-9 diagnoses can help increase pay-up, advises Kathy Palmerton, CPC, practice management consultant with the Healthcare Services Group in the accounting firm of Gordon, Odom and Davis in Sacramento, Calif.

But more often you can expect your carriers to follow Medicares lead and consider supplies as part of the expense of tests.

Generally, if an insurance carrier uses the relative value unit system (RBRVS) to determine reimbursement, supplies for most procedures will be included in their payment, explains Susan Callaway-Stradley, CPC, CCSP, an independent billing consultant in North Augusta, S.C. For example, if the urologist performs a renal biopsy (50200), the $9 needle used is no longer billable separately. Callaway-Stradley advises coders to determine whether the commercial carriers they use employ the RBRVS approach before submitting bills.

However, Palmerton says solid documentation of medical necessitytying the tests to a specific ICD-9 diagnostic code, can get tests reimbursedparticularly on appeal if you write a letter explaining this is the kind of office we have, this is the service provided, and we feel it should be paid, she says.

Urinalysis, skin test for collagen implant, urodynamics and biofeedback tests are examples of how medical necessity and documentation are crucial to getting payed.

1. Urinalysis. Urology offices also often experience problems receiving reimbursement separately for a dipstick urinalysis (81002, urinalysis non-automated, without microscopy). Many carriers and private payers consider the urine dip a part of evaluation and management (E/M) services (99201-99499), Palmerton says. But CPT considers the test to be a separate procedure. If a practice does a significant number of these tests and has documentation supporting the services provided, Palmerton believes a reimbursement denial can be appealed successfully.

Codes for Reporting Urinalysis:

81000Urinalysis by dipstick or tablet reagent for
bilirubin, glucose, hemoglobin, ketones, leukocytes,
nitrite, pH, protein, specific gravity, urobilinogen,
any number of these constituents; non-automated,
with microscopy

81002Without microscopy, non-automated

81003Without microscopy, automated

81005Urinalysis; qualitative or semi quantitative;
except immunoassays

81007Bacteriuria screen, by non-culture technique,
vommercial kit (specify type)

81015Microscopic only

2. Skin Test for Collagen Implant. The skin test for collagen implant for incontinence, which is frequently administered by urology practices, generally may be billed using only code G0025 (collagen skin test kit) says Palmerton. Not only do Medicare and many carriers disallow separate billing for the test itself and its administration to the patient, but they insist that the skin test is provided by the physician, she says. But coverage of this test differs widely among carriers, policies, states and regions of the country, points out Callaway-Stradley. Some carriers do pay for the test separately, she adds. Where separate payment is disallowed, an alternative described by one office we spoke with would be to send patients to pharmacies to purchase their own collagen kits, which then can be brought back to the physicians office where the test is administered. This approach allows the practice to bill code 95028 (intravenous intradermal tests with allergenic extracts, delayed type reaction, including reading, specify number of tests).

3. Urodynamics. According to CPT, urodynamics procedures (51725-51797) involve services for which all instruments, equipment, fluids, gases, probes, catheters, technicians fees, medications, gloves, tray, tubing and other sterile supplies are provided by the physician. Most carriers include test supplies in the administration of this test because the test itself cannot be performed without the equipment, explains Callaway-Stradley. Typically, physicians can bill for supplies using code 99070 or its HCPCS level II equivalent only if the supplies used are over and above what is normally considered part of the test procedure. CPT states that code 99070 may be used for supplies and materials (except spectacles), provided by the physician over and above those usually included with the office visit or other services rendered (list drugs, trays, supplies or materials provided).

Codes for Reporting Urodynamics:

51725Simple cystometrogram (CMG) (e.g., spinal manometer)

51726Complex cystometrogram (e.g., calibrated electronic equipment)

51736Simple uroflowmetry (UFR) (e.g., stop-watch flow rate, mechanical uroflowmeter)

51741Complex uroflowmetry (e.g., calibrated electronic equipment)

51772Urethral pressure profile studies (UPP)
(urethral closure pressure profile), any technique

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

51785Needle electromyography studies (EMG) of anal or urethral sphincter, any technique

51792Stimulus evoked responses (e.g., measurement of bulbocavernosus reflex latency time)

51795Voiding pressure studies (VP) bladder voiding pressure, any technique

51797intra-abdominal voiding pressure (AP) (rectal, gastric, intraperitoneal)


4. Biofeedback Tests. The biofeedback probe test for urinary incontinence is a less commonly used, and costly, urological test (90901, 51784, 97032). But practices face hurdles to getting reimbursed for the anal/rectal (male) and vaginal probe (female) tests required with such E/M services. Our informal survey of readers produced these options:

- Order probes directly from manufacturers. But
beware: Medicare had told some urologists that
patients cannot be required to pay up front for the
probes because the physicians are not suppliers.

- Write off the expense as a cost of doing business.

- Give the patient a prescription.

- Have the patient order the probes directly from the
company.

Tip: Billing Medicare is out of the question without a diagnostic medical equipment number for the practice.