Urology Coding Alert

Urologists work with neurosurgoens to treat patients with the Vocare bladder system, and due to the overlap in physicians, the coding can be confusing. But by knowing the proper coding for the preparation and followup of the procedure, urologists can be reimbursed.

Patients who have a Vocare bladder system implant or who will be getting one need a variety of pre-surgery and post-surgery procedures, particularly urodynamics studies. This device, developed and marketed by NeuroControl Corporation based in Valley View, Ohio, helps people with complete spinal cord injuries urinate on demand. (It also can be used for bowel evacuation.) Approved by the Food and Drug Administration in 1998, the Vocare bladder system is now used by 1,700 patients worldwide, according to Terri Zmina, PT, MBA, reimbursement specialist for NeuroControl, which works on products that help people with paralysis. Although the surgery itself is performed by a neurosurgeon, there is extensive preparation and followup, which is done by the urologist.

The Vocare bladder system works this way:

Internal: A receiver-stimulator, similar to a pacemaker, is implanted surgically under the skin in the abdomen by the neurosurgeon. This bladder system then sends electrical signals via electrodes to the nerves leading to the bladder and bowel. The signals cause the muscles of the bladder and urethral sphincter to contract. After the bladder contracts, the sphincter muscles relax, and the bladder empties.

External: The patient uses the system with an external controller the size of an audio cassette player. The controller, which can be stored when not in use, sends signals and power to the implant whenever bladder stimulation is needed.

The neurosurgeon does the laminectomy and implantation, but the urologist does all the screening, testing, immediate post-op, and follow-up post-op regarding the device, says Zmina.

Preoperative and Postoperative Procedures

The following billing codes are used for Vocare pre-operation procedures:

51600* (injection procedure for cystography or voiding urethrocystography)
51726 (complex cystometrogram [e.g., calibrated electronic equipment])
51741 (complex uroflowmetry [e.g., calibrated electronic equipment])
51795 (voiding pressure studies [VP]; bladder voiding pressure, any technique)
51797 (voiding pressure studies [VP]; intra-abdominal voiding pressure [AP] [rectal, gastric, intraperitoneal])


Urologists also need to know the codes for the radiological procedures done preoperatively:

76770 (echography, retroperitoneal [e.g., renal, aorta, nodes], B-scan and/or real time with image documentation; complete)

74430 (cystography, minimum of three views, radiological supervision and interpretation)

74420 (urography, retrograde, with or without KUB)

Note that the above codes, with the [...]