Urology Coding Alert

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Urodynamic studies are investigative procedures used to assess a patient's bladder function and determine what might be causing problems such as incontinence or urine retention. As an initial urodynamic study, a cystometer is used to measure the bladder capacity and various bladder pressures, and the test itself is known as a cystometrogram. Read on for a rundown of factors you need to consider before coding the test.

Get Familiar With Your Firstline Code Choices

CPT^® includes several codes related to a cystometrogram, based on whether the test is considered simple or complex or associated with other urodynamic studies.

• 51725 – Simple cystometrogram (CMG) using a (e.g., spinal manometer)
• 51726 – Complex cystometrogram (i.e.. calibrated electronic equipment)
• 51727 - Complex cystometrogram (i.e., calibrated electronic equipment); with urethral pressure profile studies (i.e., urethral closure pressure profile), any technique, or valsalva leak point pressure
• 51728 -  ... with voiding pressure studies (i.e., bladder voiding pressure), any technique
• 51729 - ... with voiding pressure studies (i.e., bladder voiding pressure) and urethral pressure profile studies (i.e., urethral closure pressure profile), any technique or valsalva leak point pressure.

"The cystometrogram indicates if the detrusor muscle is functioning properly and detects the capacity of the bladder and any abnormal detrusor and/or sphincter contractions," explains Michael A. Ferragamo, MD, FACS, clinical assistant professor at the State University of New York in Stony Brook. "If the patient's incontinence is due to stress, the cystometrogram is usually normal. Code 51725 is the only choice for a simple CMG. A simple CMG uses a spinal manometer to determine bladder pressures and is rarely performed as a single procedure."

However, one of three primary codes a physician may bill for a urodynamic study are 51727, 51728, and 51729. In these cases, the physician fills the bladder through a catheter and measures the pressures with calibrated electronic equipment.

If your urologist also performs a urethral pressure profile (UPP) or leak point pressure during the encounter, report 51727. For a CMG and voiding pressure study, report 51728. For a CMG with voiding pressure study and a UPP or leak point pressure, use 51729.

Look Further for Additional Studies and Their Service Codes

A typical urodynamic study consists of a complex CMG (as described by codes 51727-51729) and a complex uroflowmetry. A flow rate study tells the physician the actual flow of urine on voiding and whether the flow is free or obstructed. For a urodynamic study use uroflowmetry code 51741 (Complex uroflowmetry [e.g., calibrated electronic equipment]).

Explanation: A uroflow measures how much liquid the patient urinates, in cubic centimeters per second. The rate is the ratio of volume over time. For example, a physician may be watching a patient who has symptomsof outlet obstruction, as in prostatism. To gauge how well the patient is responding to medicationmeant to shrink the prostate, the doctor performs a uroflow study. The flow rate may be 15cc/second three months into treatment, compared to a flowrate of three before treatment, clearly demonstrating an improvement. Normally, the physician measures the flow rate just before and just after the cystometrogram. Reimbursement for flow studies includes pre- and post-testing, so you can bill only one unit for the service.

During a complete urodynamic study, the physician may also perform an electromyography (EMG) and a bladder voiding pressure (VP) study. For EMG studies, the doctor places patch electrodes on the perineum to measure electrical and muscular activity of the perineal muscles and urinary sphincter.

For these studies, Ferragamo says you may report one or more of the following codes if performed:

• 51784 - Electromyography studies (EMG) of anal or urethral sphincter, other than needle, any technique or
• 51785 -  Needle electromyography studies (EMG) of anal or urethral sphincter, any technique
• +51797 - Voiding pressure studies, intra-abdominal (i.e., rectal, gastric, intraperitoneal) (List separately in addition to code for primary procedure)
• 51798 - Measurement of post-voiding residual urine and/or bladder capacity by ultrasound, non-imaging.

Coding tip: You may use +51797, an add-on code, only in conjunction with primary CPT^® codes 51728 or51729.

When reporting a radiological voiding study in addition to a complex urodynamic study, you may also report:

• 51600 (Injection procedure for cystography or voiding urethrocystography) for injection with contrast
• 74455-26 (Urethrocystography, voiding, radiological supervision and interpretation) for radiological supervision and interpretation of voiding cystourethrogram.

Final advice: Therefore, for a complete urodynamic study, you should report:

• 51729
• 51797
• 51741
• 51784