Urology Coding Alert
Use CCI Edits to Combat Denials for 51795 and 51797
Question: Private carriers keep denying our claims for 51795 and 51797 when they are billed together. I feel that we should be getting paid separately for these. What is the problem?
Wyoming Subscriber
Answer: When you are getting denied for procedures that you think should be separately payable, it is a good idea to follow your instincts but only after you have consulted the CCI edits for any bundles that might be the cause of your denials.
51795 (Voiding pressure studies [VP]; bladder voiding pressure, any technique) and 51797 ( intra-abdominal voiding pressure [AP] [rectal, gastric, intraperitoneal]) are technically not considered bundled according to Correct Coding Initiative edits. However, it appears that your private carrier has selectively bundled 51795 and 51797 as part of its local policy.
Follow CPT Coding guidelines and bill 51795 and 51797-51 (Multiple procedures) regardless of whether you are receiving denials. You can combat your carrier's policy by sending a copy of the cci Edits that do not bundle the two procedures and a copy of the CPT urodynamics guidelines that instruct coders to bill multiple urodynamics codes using modifier -51.
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