Urology Coding Alert

When a urologist plans to inject collagen in the area of the urethra to solve incontinence problems, the physician must first make sure that the patient will not have an allergic reaction to the collagen. To do this, the urologist performs a skin test. How should you bill for the test?

Two different codes apply for the collagen skin test. One is for the supplyG0025 (collagen skin test kit). Even though G0025 is an HCPCS code, you should use it for all patients, not just Medicare patients, says Scott Radle, business manager for Accent Urology, a two-urologist practice in St. Louis, Mo. We still bill it for commercial payers. The other code is for the test administration 95028 (intracutaneous (intradermal) tests with allergenic extracts, delayed type reaction, including reading, specify number of tests).

We do the skin test on patients who are candidates for the collagen implant, explains Radle. If there is no reaction after a month, the patient can be scheduled for the surgery. The collagen is injected into the forearm, and the patient is given a card to take home that advises the patient how to check for a reaction. If the patient does have a reaction, he/she would come in to show the reaction to the physician. At that session, we would bill for an office visit (99201-99205 or 99212-99215), and the urologist and the patient would discuss other forms of treatment for the incontinence, says Radle.

You get the collagen injection kit from Bard, the company that makes the implant, says Radle. The kit includes the medication, the syringe and adaptors, needles and everything else needed to do the test.

Commercial payers sometimes have a problem with this procedure, and deny both codes (95028 and G0025) because they dont know what the codes are for, says Radle. When they dont know, they deny. The quickest solution to this problem is to call Bard, says Radle. When I call Bard, they have a reimbursement specialist who gives me advice on how to code for this, especially with commercial payers. (To reach Bard, call (800) 227-3357. Ask for Bard Medical Division.)

Can you bill for an evaluation and management (E/M) service as well as the 95028? If the office visit is just for the test administration, you cant bill an E/M visit, says Radle. But if you provide another service, such as talking about the implant itself, you can bill an office visit.

Determining the Diagnosis Codes

For proper reimbursement, its very important to use the diagnosis code that most closely reflects the reason that the collagen skin test is being administered. The test is being done because ultimately the patient needs a collagen implant (if there is no sensitivity to the collagen). So you should use 599.82 (other specific disorders of urethra and urinary tract; intrinsic [urethral] sphincter deficiency) as the primary diagnosis code.

Secondary diagnosis codes depend on whether the patient is male or female. For a female, use 625.6 (stress incontinence, female); for a male, use 788.32 (stress incontinence, male). Some payers may require secondary diagnoses in addition to the 599.82, says Radle.

Other diagnosis codes that Medicare will cover for the implant itselfand therefore for the skin testare 596.8 (other specified disorders of the bladder), 753.9 (unspecified anomaly of urinary system), 788.3x (as a secondary diagnosis), 867.0 (injury to bladder and urethra, without mention of open wound into cavity), 867.1 (injury to bladder and urethra, with open wound into cavity), V15.2 (other personal history presenting hazards to health, surgery to other major organs), and V15.3 (irradiation, previous exposure to therapeutic or other ionizing radiation).

The Implant Procedure The collagen implant, code 51715 (endoscopic injection of implant material into the submucosal tissues of the urethra and/or bladder neck), for incontinence problems works by puffing up the tissue around the urethral sphincter or bladder neck to tighten it, explains Scott Radle, business manager for Accent Urology, a two-urologist practice in St. Louis, Mo. Occasionally, other procedures are performed at the same surgical session, but usually when the implant procedure is scheduled, that is the only service provided in the session. (Note that the CPT descriptor for the procedure includes endoscopicin other words, cystoscopyso the payer would deny certain cystoscopy procedures if billed with the implantsuch as 52000-52010, 52214, 52224, 52281, 52283, and 52285.) It should be noted that sometimes code 51715 is not covered by insurance companies, says Radle. They lump the 51715 in with the primary procedureusually some kind of cystoscopy. But depending on what the surgeon is doing during the session, its possible that the cystoscopy code could pay more than the 51715, Radle adds. Before doing the skin test, you need to consider the fact that Medicare will not cover the implant procedure unless the patient has had no improvement in the past year. If there has been improvement, Medicare will not pay for the implant procedure, so you should not bother with the skin test. If, however, the patient has a new occurrence of incontinence following successful treatment with collagen implants within six to 12 months of the original implant, and there is evidence that the patient will benefit from an additional session, Medicare will allow payment for 51715. In this case, however, the skin test will not be necessary, since it will have already been done prior to the first collagen implant.