Urology Coding Alert

Question: In the article "Think You Have a Handle on the 2012 Code Changes? Find Out Fast" in the February issue of Urology Coding Alert, I read the updated information about NMP-22 BladderChek being a CLIA-waived test still even with the new code, 86386. Based on the information about the codes 86386 now crosswalks to, we expected a lower payment this year. However, we have actually received more money than we did last year on these tests. Are we being overpaid? Should we be reporting the error to our carrier?

Louisiana Subscriber

Answer: No, you should not be reporting an overpayment to your carrier. You are, most likely, being paid correctly.

"Though the majority of states will see reduced Medicare reimbursement in 2012 versus 2011, there are a few states being reimbursed at a higher level," says Teri McArdle, RN, strategic reimbursement project manager of urology operations at Alere in Waltham, Mass. The following states have a higher Medicare fee schedule rate for NMP-22 BladderChek in 2012: Mississippi, parts of New York, Arkansas, Louisiana, parts of Missouri, New Mexico, Oklahoma, Georgia, Pennsylvania, Ohio, Alabama, Rhode Island, and Illnois.

Best bet: "Practices should refer to their state specific Medicare fee schedule and private pay/contracting fee schedules for their practice's reimbursement amount associated with CPT code 86386," McArdle advises.