Urology Coding Alert

Hint: You cannot report this urodynamics code with 51726 anymore.

CPT Codes 2010 wreaked havoc on your urodynamics codes -- and if you're more confused than ever about +51797 in particular, you not alone. Knowing what to report with +51797 can help you save $138 per claim.

1. Can I Report +51797 Alone?

You can never report +51797 (Voiding pressure studies, intra-abdominal [i.e, rectal, gastric, intraperitoneal] [List separately in addition to code for primary procedure]) on its own. This code is an add-on code, which means you should never report +51797 without also listing a "primary" procedure. (Take a look at the sidebar "Learn the Ins and Outs of Add-on Codes to Ensure Payable Claims" for more about how to use add-on codes.)

"+51797 has always been an add-on code and last year we were only allowed to use +51797 with 51795 (Voiding pressure studies; bladder voiding pressure, any technique)," says Linda Cahill, CPC, clinical coordinator/lead coder, for MidWest Urology Inc. in Cincinnati, Ohio.

How it works this year: CPT deleted 51795 for 2010. Therefore, the directive indicating which codes you can use with +51797 changed. This year you can only report +51797 with 51728 (Complex cystometrogram [i.e., calibrated electronic equipment]; with voiding pressure studies [i.e., bladder voiding pressure], any technique) or 51729 (... with voiding pressure studies [i.e., bladder voiding pressure] and urethral pressure profile studies [i.e., urethral closure pressure profile], any technique), which are the new inclusive codes for 2010.

Pitfall: Many coders have been reporting +51797 with 51726 (Complex cystometrogram [e.g., calibrated electronic equipment]). "One cannot expect payment for +51797 when billed only with CPT code 51726" warns Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology at the State University of New York at Stony Brook. For 2010 you can expect payment for +51797 only when you code it with 51728 or 51729.

Money talks: "I do not believe that the change in how we use add on code 51797 has cost the urologist in terms of reimbursement," Cahill says. "However, the changes made to the inclusive codes are costing the urologist reimbursement." Since this year you should report only one code (51728) for two urodynamic studies previously coded with two codes, or one code (51729) for three urodynamic studies previously coded with three codes, your practice is now automatically losing reimbursement this year as compared with last year's reimbursement. "The allowable for the new codes is substantially lower than the allowables for the codes as they were billed separately," Cahill laments.

Since you are already losing money, you must ensure you're capturing +51797 payments. Miscoding and denials for +51797 could cost your practice up to $138 per claim -- 3.84 relative value units (RVUs), based on the 2010 Medicare Physician Fee Schedule and the conversion factor (CF) of 36.0846.

2. Do I Need to Add a Funny Symbol Before +51797?

Because +51797 is an add-on code, you will often see the plus sign (+) in front of it to indicate that you cannot report this code on its own. The plus sign appears in the CPT manual as well as in many textual references. You do not need to add the plus sign on your claim form when submitting +51797 to payers.

Since +51797 was also resequenced -- moved out of numerical order -- in the CPT manual this year, the AMA designated that change with a pound sign (#). Many coders have wondered if they need to add a # on their claim now. The answer is no. "The coding for +51797 does not require a # sign in front of it," Cahill explains.

Bottom line: To report this service you only need the actual code  51797 -- on your claim form. "The + and # signs are indicators used in the CPT manual for information about the particular code, and are not necessary for coding this CPT code or for billing purposes," Ferragamo stresses.

3. What If I'm Coding Properly and Still Receiving Denials?

"There have been some problems in getting paid for CPT code 51797 by several carriers, including some Medicare carriers," Ferragamo explains. "+51797, properly coded in addition to 51728 or 51729, has unfortunately been denied payment ... although this coding has been accurate. The problem is that these carriers have not updated their programs with the 2010 changes for billing urodynamic studies and do not appreciate that +51797 should be billed with CPT codes 51728 or 51729."

If you're receiving denials on +51797, but you think you're reporting the code properly, talk to your payer rep.

Some Medicare carriers, for example, have had a glitch in their system that's resulting in improper +51797 denials. "We just had our first rejection on +51797," says Laura Cwiklinski, office manager at Urology Partners Inc. in Cleveland. "We went to a second level rep at Medicare and have found out that there is a glitch in the system on that code. They are working on fixing it." The Medicare rep told Cwiklinski that the claims will automatically be paid once the error is fixed on the carrier's side.