Urology Coding Alert

Question: How does the use of video equipment in urodynamics studies affect coding and reimbursement?

Virginia Subscriber

Answer: The addition of any component to standard procedures, such as adding video equipment to urodynamics studies, makes coding and reimbursement more complicated.

Urodynamics, diagnostic procedures used to evaluate voiding disorders, are located in the urinary system surgery section of CPT, 51725-51798. For 2003, most of the urodynamic services received a substantial increase in reimbursement, despite the decreased conversion factor, due to substantial increases in practice expense RVUs.

When you add the video component to urodynamics studies, report the codes that reflect the contrast agent injection, the reading of the video films and fluoroscopy where applicable, as well as the urodynamic components.

If a complex cystometrogram is performed with video films requiring contrast agent in the bladder and fluoroscopy, you should use 51726, 51600* (Injection procedure for cystography or voiding urethrocystography), 74455 (Urethrocystography, voiding, radiological supervision and interpretation) and 76000 (Fluoroscopy [separate procedure], up to one hour physician time, other than 71023 or 71034 [e.g., cardiac fluoroscopy]).

Medicare and most private and third-party payers will pay for each individual component that the physician performs and documents if the procedure codes and corresponding diagnosis codes reflect medical necessity. When multiple urodynamics codes are reported, you should list the most expensive (i.e., highest-reimbursed) code first, followed by the other CPT codes, each with modifier -51 (Multiple procedures).

If your urology group uses video equipment made available by a hospital, you must append modifier -26 (Professional component) to the radiology codes 74455 and 76000 to indicate that only the professional component, or reading of the video, was provided. Be sure to include an extensive radiology report when billing for radiology interpretations.

When urodynamics studies are performed without video equipment, you can typically expect to receive full payment (80 percent of the allowed amount) for the most expensive procedure performed in Medicare's case, the most expensive urodynamics code for 2003 is 51726 and Medicare will pay 100 percent for this code and 50 percent of the fee for all other components reported.

According to CPT guidelines, all urodynamics procedures require the direct supervision of a physician. The urodynamics codes also imply that all instruments, equipment, fluids, gases, probes, catheters, technician's fees, medications, gloves, trays, tubing and other sterile supplies are provided by the physician. Otherwise you must append modifier -26 to the code, for example, when done at a hospital outpatient department and the supplies are not the physician's.

Notice that 51798 (Measurement of post-voiding residual urine and/or bladder capacity ...) is a new addition to CPT 2003. Prior to the addition of this code, coders used 76775 or 76857 for simple bladder scans for non-Medicare payers and G0050 for Medicare claims. CPT code 51798 can be considered equivalent to Medicare's G0050 (Measurement of post-voiding residual urine and/or bladder capacity by ultrasound), which has been deleted from HCPCS 2003.