Urology Coding Alert

Question: Sometimes my urologist has the technician take a video of urodynamics with the intent of watching it later and interpreting the results. Can we still bill CPT 51600 and CPT 74455 for the urodynamics and the interpretation even though the physician was not present at the time the test was performed?

Montana Subscriber


Answer: The circumstances you describe happen regularly in urology offices, and if you don't know the rules that correspond to 51600* (Injection procedure for cystography or voiding urethrocystography) and 74455 (Urethrocystography, voiding, radiological supervision and interpretation), you could be in breach of Medicare's billing guidelines.

 For Medicare, you can only report 51600 if you satisfy the "incident-to" requirements. To meet the incident-to requirements, the urologist must be present in the office suite at the time the procedure is performed. So if this was a Medicare patient, you would not charge for the urodynamics services performed by your technician because the urologist was not in the office suite to provide the necessary personal and direct supervision.

 For Medicare, you can only report 74455 for the physician's interpretation and report if the urologist has personally supervised (was present in the room where the study was performed) the urodynamics test and has a documented interpretation of the video.

 But for many private payers and commercial carriers, the rules for reporting 51600 and 74455 may differ. You should ask your local carrier whether you can report the services.

 When the urologist meets the carrier's supervision requirements and interprets the study in the office at a later date such as the day after the video was taken and the urodynamics studies were performed you should report the global charges for the urodynamics studies performed. If the technician performed a video study and the urologist read the films and submitted a report, code for the reading of the films, 74455, and the instillation of contrast medium, 51600. Code the procedures the date the study was performed, even if the interpretation was a day later.

 But if the urodynamics studies were performed in a facility or hospital setting and interpreted by a radiologist employed by that facility or a radiology office, you cannot charge for your urologist's viewing of the video. But you may be able to use your urologist's reading and viewing of the x-ray study toward the medical decision-making component of an E/M service.