Urology Coding Alert

Question: We perform bladder test checks in the office fairly often. Recently we have been receiving denials from Medicare for these services. How should we be reporting the test?

Michigan Subscriber

Answer: Nuclear matrix protein-22 (NMP-22), also known as the Bladder Test Check, is performed to detect abnormal proteins in the urine which might suggest the presence of a bladder tumor or carcinoma in situ. This test is most often performed in the office to monitor bladder cancer between cystourethroscopic procedure intervals.

Old way: In the past, you billed this services using 86294 (Immunoassay for tumor antigen, qualitative or semi-qualitative [eg, bladder tumor antigen]) with modifier QW (CLIA waived test) attached.

Right now: According to a Part B Medicare notification, dated Oct. 19, 2011, you should use 88299 (Unlisted cytogenetic study) to report this test until the end of 2011. Remember to add "NMP-22" in box 19 of the CMS-1500 form or in an equivalent space for the electronic submission to help explain the use of an unlisted CPT® code.

In the new year: A parenthetical note was added to 86294 in the 2012 CPT® manual that states: for qualitative NMP22 protein, use 86386. Code 86386 (Nuclear Matrix Protein 22 [NMP22], qualitative) is a new 2012 CPT® code for NMP22 protein testing. Therefore, when your urologist performs a Bladder Test Check, or NMP-22 protein test, report 86386 beginning Jan. 1, 2012.

Use diagnosis code V10.51 (Personal history of malignant neoplasm of bladder).