Urology Coding Alert

Question: Medicare is denying 51741-26 when billed with 52000, 51726-26, 51784-26, 51795-26 and 51797-26 (all urodynamics codes) with ICD-9 Codes ICD-9 344.61, calling it a "noncovered service because this is not deemed a medical necessity by the payer." Which diagnosis should we use?

Florida Subscriber

Answer: Medicare and most private carriers consider ICD-9 code 344.61 (Cauda equina syndrome; with neurogenic bladder) to be an eligible condition for urodynamics procedures. You do not mention, however, if the urologist performed these procedures in your office or in a separate facility. Modifier -26 (Professional component) should not be used if your practice owns the equipment, does the test and you interpret the results in your office. Review your carrier's LMRP for diagnoses payable for the above urodynamic studies.