Code Urodynamics Correctly to Avoid a Flood of Rejections
Published on Thu Jan 01, 2004
Take pressure off your bottom line with these tips Urodynamics diagnosis and procedure codes don't have to be uncharted waters if you're following this rule of thumb: Urodynamics tests are diagnostic procedures, not part of a routine examination.
Typically, urodynamics sessions consist of uroflow (51741 or 51736), cystometrogram (CMG) (51725 or 51726), and leakpoint pressure (LPP) tests (51795), mainly for diagnosing intrinsic sphincter deficiency (599.82), says Morgan Hause, CCS, CCS-P, coding specialist with Urology of Indiana in Indianapolis.
Many private payers try to bundle 51795 into 51726 because they are performed at the same session. You can support separate billing if you have separate reports at each machine, he says.
"We do LPP and complex CMG before sacral nerve stimulation because we want to know how the patient might benefit from a nerve stimulator," Hause says. Interestingly, a simple CMG pays more ($328.49) than a complex ($324.81), according to the Physician's Fee Schedule, because a simple CMG requires the provider to be present throughout the test.
The interpreting physician should code urodynamics procedures based on the resulting diagnosis. If the test result is normal, use the patient's complaint. For example, if the test reveals intrinsic sphincter deficiency (ISD), use ICD-9 599.82, but if the patient's complaint is not ISD, use stress incontinence (625.6) as the diagnosis.
Although ISD and stress incontinence are the most common diagnoses in urodynamics testing, carriers with local medical review policies for these codes have long lists of payable diagnoses, some including new additions as of last fall: 598.9 (Urethral stricture, unspecified), 600.00 (Hypertrophy [benign] of prostate without urinary obstruction) and 600.91 (Hyperplasia of prostate, unspecified, with urinary obstruction). Urodynamics Tests Are Not for Routine Screening Do not bill any of the urodynamics codes unless there is a sign or symptom of voiding dysfunction. You may not use urodynamics procedures for screening or routine exams.
Voiding pressure studies (51795 and 51797) evaluate different functions. Code CPT 51795 refers to the measurement of the ability of the detrusor muscle to contract, and can detect outlet pressure obstruction. Urologists often perform 51795 with 51726 to diagnose obstruction.
Code 51797 refers to a procedure to compare intra-abdominal pressure to detrusor muscle function.
The cystometrogram (51725) indicates if the detrusor muscle is functioning properly - it detects the capacity of the bladder and abnormal detrusor sphincter contractions.
If the patient's incontinence is due to stress, the cystometrogram is normal. Use 51726 when you have calibrated electronic equipment that performs simultaneous measurements of intra-abdominal, total bladder and true [...]
