Urology Coding Alert

Medicare covers multiple urodynamics tests, but some private payers dont. Across the country, urology coders have been getting denials when using code 51726 (complex cystometrogram [e.g., calibrated electronic equipment]) along with:

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

51741 complex uroflowmetry, (e.g., calibrated electronic equipment);

51795 voiding pressure studies (VP); bladder voiding pressure, any technique; or

51797 voiding pressure studies (VP); intra-abdominal voiding pressure (AP)(rectal, gastric, intraperitoneal).

Medicare doesnt bundle these codes with the cystometrogram (51726). Some private payers, however, want to save money by bundling these codes. But if you can prove medical necessity, you can be reimbursed for each study. Support medical necessity by diagnosis codes and, if needed, a letter explaining specific circumstances relating to a particular patient.

All five of these procedures present a complex evaluation to diagnose and treat a patient with a voiding problem, says Ira G. Keselman, MD, FACS, of Shore Urology in Long Branch, N.J. These procedures are needed to determine whats going on with the bladder and to detect other problems with the detrusor muscle and the sphincter. At Shore Urology, all urodynamics procedures are performed in an ambulatory surgery center, says Keselman. In some practices, the procedures are performed in a hospital. If the urologist interprets the readings but does not own the equipment, append modifier -26 (professional component) to the procedure code.

How the Five Codes Work Together

Keselman describes the five codes, and explains why they are necessary in combination when assessing a patient. Look for signs and symptoms in the urologists documentation to determine medical necessity for appropriate coding.

Cystometrogram (51726) The cystometrogram is the only one of these five procedures that involves filling the bladder with a fluid via a catheter to perform the test. The cystometer measures the bladder capacity, or bladder pressure. A complex cystometrograph measures the subtracted pressure from the bladder pressure and the abdominal pressure so we can get the true detrusor pressure, explains Keselman. We can tell the difference between an involuntary detrusor contraction and incontinence. This is the procedure that some private payers want to bundle with the other four procedures.

Flow studies (51736 and 51741) The flow rate tells the urologist how the bladder is functioning and what the patient perceives. Flow studies can tell the urologist whether there are neurological lesions or obstruction lesions. A cystometrogram cant determine that, because a cystometrogram measures bladder content rather than bladder function. A uroflow, simply, is a measure of how much liquid is urinated, in [...]