Urology Coding Alert

Question: My physicians have just started using the new CaverMap device when performing a nerve sparing radical prostatectomy. The codes that I have been using to report the use of the CaverMap device are 95920 (intraoperative neurophysiology testing, per hour [list separately in addition to code for primary procedure]), 54240 (penile plethysmography), 64550 (application of surface [transcutaneous] neurostimulator), and 95900 (nerve conduction, amplitude and latency/velocity study, each nerve; motor, without F-wave study) along with the radical prostatectomy code. Have you encountered any other facilities that are using this device and if so what codes are being used? I am also finding that Medicare is rejecting 95900 and 95920 as not medically necessary.

Wisconsin Subscriber

Answer: The CaverMap device is an electronic probe designed to help the surgeon locate and work around the cavernosal nerves that transmit the signals that spark an erection. The nerves are too small to see and are entwined with blood vessels in a skein of tissue called the neurovascular bundle. When the surgeon points the CaverMap device at the neurovascular bundle and applies a slight electrical current, signals are shown on the monitor if the current hits the correct nerve. The codes you are using appear to be correct except that 95920 includes 95900 according to the Correct Coding Initiative edits and thus would not be payable separately. Note also that 95920 should be reported with a -26 modifier (professional component) by the surgeon. Many Medicare carriers have Local Medical Review Policies (LMRPs) for 95920 that do not include prostate cancer as a covered diagnosis, possibly because this is such a new device. Medicare rejections for medical necessity should be appealed in this case as most LMRPs specify that if the surgery is not one of those listed above, the service will be evaluated on an individual basis.