Urology Coding Alert

Everything you need to know to collect your fair share for urodynamics

Code urodynamics sessions, 51741 or 51736; cystometrogram (CMG), 51725 or 51726; and leakpoint pressure (LPP) tests 51795 mainly for diagnosing intrinsic sphincter deficiency (599.82), according to Morgan Hause, CCS, CCS-P, coding specialist with Urology of Indiana in Indianapolis. To ensure reimbursement, make sure physician notes are very specific.
 
"What I do is I require my physicians to dictate in their procedure note if the patient is going to have to return for something like that, because sometimes it's not planned," says Wendy Dicus, CPC, coding supervisor at Alaska Billing Services in Anchorage.

Some Tests Are Excluded

One important fact you can't afford to overlook is that some diagnostic tests are not part of the global payment.
 
Carriers typically deny urodynamics tests if they are performed within the postoperative period of a surgery.
 
For example, sometimes after a TUMT (53850, Transurethral destruction of prostate tissue; by microwave thermotherapy) or a transurethral prostatectomy (52601, Transurethral electrosurgical resection of prostate, including control of postoperative bleeding, complete ...), uroflow testing might be needed.
 
Both Medicare and some private payers, however, will require modifier -79 (Unrelated procedure or service by the same physician during the postoperative period) to receive payment for urodynamic studies when they are performed within the 90-day global period of the above urodynamics procedures.

Watch the Modifier Rules

Private payers might require you to append modifier -24 (Unrelated evaluation and management service by the same physician during a postoperative period) or modifier -79 to the procedures listed above, but most private payers also limit the use of modifier -79 to E/M services, not surgical ones.
 
Payer confusion about the nature of urodynamic testing makes urodynamic coding within the global period difficult. Here's why: Diagnostic tests such as x-rays, for example, are not part of the global payment for the procedure and are fully payable.

Testing Is Diagnostic

Urodynamics testing is also diagnostic, and carriers should pay for it. Because the AMA places urodynamics codes in the surgery section of CPT Codes instead of the medicine section, the codes are viewed as surgical codes and are subject to global and surgical guidelines.
 
That said, urodynamics studies are not surgical procedures to correct a postoperative complication but are diagnostic procedures used to evaluate unusual voiding complaints such as urgency (ICD-9 788.63), urgency incontinence (788.31), and incontinence (788.37) following a prostatectomy.
 
They should be reimbursed because they are diagnostic procedures within the global period of the prostatectomy rather than complications arising from the surgery.
 
"They [urodynamics codes] should be in the medicine section at the very end where they have EKGs, etc.," Dicus says, or coders must come up with a modifier for the specific problem.

Modifier -79 Required

You must append modifier -79 to each study to receive payment for the above diagnoses or other functional bladder disorders, such as bladder atony (596.4) or hypertonicity of the bladder (596.51), used to indicate the medical necessity for the urodynamics. These diagnoses are different and distinct from the diagnosis, BPH with urinary obstruction (600.01), linked to the prostatectomy.
 
Append modifier -79 to each urodynamic study performed when reporting urodynamics during the follow-up period of a surgery, therefore indicating that the urodynamic studies are being performed for an unrelated problem. This would apply both to private and Medicare carriers alike.
 
Private payers usually allow payment, stating that a new problem exists during the postoperative period, and it can be separately reported with the appropriate modifier.   

Depending on the service provided, append modifier -24 for unrelated E/M visits in the global period or modifier -79 for unrelated surgery (urodynamics) during the global.