Urology Coding Alert

Question: According to the Medicare Carriers Manual, CPT Code 74455 must have personal supervision. So even if the nurse performs the videourodynamics, we do not charge this unless the physician is in during the procedure. Does CPT 51600 fall under incident-to guidelines? I'm not comfortable reporting both 51600 and 74455 unless the physician is in the room during the procedure.

New Mexico Subscriber Answer: You are correct; 74455 (Urethrocystography, voiding, radiological supervision and interpretation) does require personal supervision - the urologist must be in the room where the study and interpretation of the cystourethrogram are taking place. However, if the nurse has been trained to perform 51600 (Injection procedure for cystography or voiding urethrocystography), and this catheterization procedure is within a nurse's scope of practice as defined by your state, the nurse may perform this service and you can bill for it.

For 51600 to meet the incident-to requirements, the urologist must be present in the office suite at the time the procedure is performed, but not necessarily in the same room. So, if the urologist is in the office suite but not personally supervising the videourodynamics, you can report CPT code 51600, but not 74455.