Urology Coding Alert

Know how to code the tests, supplies and procedures -- and see a $300 pay up

Coding for urethral implants to treat incontinence may seem straightforward -- but there are a few things to watch out for. Our coding experts will help you avoid the common pitfalls with these foolproof tips.

Avoid Adverse Reactions When Coding Skin Tests

Supplies: When a urologist plans to inject collagen into the urethra or bladder neck to treat incontinence problems, the physician must first make sure that the patient will not have an allergic reaction to the collagen. To do this, the urologist performs a skin test -- and you deserve reimbursement for this service.

Don't report HCPCS Level II code G0025 (Collagen skin test kit) -- CMS deleted that code in 2003 and replaced it with Q3031 (Collagen skin test). As yet, Q3031 has no relative value units (RVUs) assigned to it by the Resource-Based Relative Value Scale payment system, and the Medicare Physician Fee Schedule gives it a status indicator "B," meaning that it will always be bundled with other services. You may need to check with other payers to determine if they will pay for these supplies.

Most carriers won't pay for the supplies, since C.R. Bard Inc., the manufacturers of Contigen collagen, also provides the test kits free of charge, says Martha Guyer, CPC, coding specialist for Piedmont Urology Associates in High Point, N.C. Contact a Bard representative for a free test kit. To reach Bard, call (800) 227-3357. Ask for Bard Medical Division.

Do report CPT 95028 (Intracutaneous [intradermal] tests with allergenic extracts, delayed type reaction, including reading, specify number of tests) for the skin test to rule out allergy to the implant material.

Consider Medicare's Rules

Hidden trap: Before doing the skin test, you need to consider the fact that Medicare will not cover the implant procedure unless the patient has had no improvement in the past year. If there has been improvement, Medicare's Coverage Issues Manual dictates that Medicare will not pay for the implant procedure, so you should not bother with the skin test.

Also, check with your carrier for any local coverage determinations or local medical review policies. LCDs and LMRPs might have additional restrictions. In Indiana, for example, the urologist must make sure there is no reaction four weeks after administering the test before he can proceed with the implant, says Dena Townsend, CPC, coding specialist for Associated Urologists in Indianapolis.

Stick to the Right Diagnosis for Implants

Once the test is completed, and the patient shows no adverse reaction to the collagen, the urologist can proceed with the implantation. For the implant procedure, use 51715 (Endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck).  When performed outside the hospital in the urologist's office, also report L8603 (Injectable bulking agent, collagen implant, urinary tract, 2.5-ml syringe, includes shipping and necessary supplies) to your local carrier -- not your DMERC -- for the supplies.

Indicate the implant material used, the amount implanted and the price paid in box 19 of the CMS-1500 form (or the corresponding field in the electronic form). But be aware that "Medicare covers up to five separate collagen implant treatments in patients with intrinsic sphincter deficiency, who have passed a collagen sensitivity test," according to a note in the HCPCS Level II manual.

Good idea: Link the test and implant procedures to ICD-9 code 599.82 (Intrinsic [urethral] sphincter deficiency [ISD]) as the primary diagnosis. Some carriers may require secondary diagnoses, Guyer says. Secondary diagnosis codes may depend on whether the patient is male or female. For a female, use 625.6 (Stress incontinence, female), and for a male, use 788.32 (Stress incontinence, male). Other diagnosis codes that Medicare may cover for the implant and test: