Urology Coding Alert

Question: I’m unsure how to bill for urodynamics that was performed by a nurse practitioner but interpreted by a physician on a separate date. Both providers are in thesame practice, and own the equipment. I’m considering billing:

• 51728, TC under the NP on the date the test was performed
• 51728, 26 under the physician on the date he interpreted the test.

This is not “incident to” as the physician was not in the suite when the test was performed. The NP has his own NPI to bill Medicare. I have been told in the past that 51728 should be billed with no modifiers since the providers are in the same practice and the service cannot be unbundled. What do you recommend?

Arizona Subscriber

Answer: This scenario does not represent an “incident to” billing situation but in fact a supervisory requirement. These procedures are payable with the technical and professional modifiers as the services were performed on separate days. Therefore, your suggested billing is correct:

• 51728 (Complex cystometrogram [i.e., calibrated electronic equipment]; with voiding pressure studies [i.e., bladder voiding pressure], any technique) with modifier TC (Technical component) for the nurse practitioner performing the test
• 51728 with modifier 26 (Professional component) for the physician’s interpretation.

Be aware: Some payers might require you to bill the professional component with the same date of service as the test, even if the test is read on a different date.