Urology Coding Alert

Test your coding knowledge. Determine how you would code this situation before looking at the box below for the answer.
Question: When a cysto is performed in the office at the same time as CMGs, do I need to use modifier -51? We use modifier -26 (Professional component) at the hospital, but in the office we own our own CMG equipment. West Virginia Subscriber  


Append -51 to Cysto Code When Performed with CMGs Answer: You are definitely on target assuming that you need modifier -51 (Multiple procedures) to properly code a cystourethroscopy with a cystometrogram (CMG) in the office, but the real challenge is determining to which code you append modifier -51. When a CMG is performed in the office setting, it has a higher relative value unit (RVU) and allowed reimbursement amount than a cystoscopy, therefore you should list the CMG before the cysto on your HCFA1500 form, appending modifier -51 to the cysto code. There are a few things you should take notice of with regard to the urodynamics codes:

First, 51726 (Complex cystometrogram [e.g., calibrated electronic equipment]), which is considered a "complex" cystometrogram, actually pays less than the "simple" CMG, CPT 51725 (Simple cystometrogram [CMG] [e.g., spinal manometer]). The reasoning: A higher level of clinical expertise is required for use of a manometer, usually used directly by the provider.

Second, it is not uncommon for a "leak point pressure" test, 51795 (Voiding pressure studies [VP]; bladder voiding pressure, any technique) or an intra-abdominal voiding pressure study, 51797 ( intra-abdominal voiding pressure [AP] [rectal, gastric, intraperitoneal]), to be done along with a CMG. These procedures pay less than 51726 and are sequenced after the CMG and will require modifier -51 (Multiple procedures).

Keep in mind that an office needs to file a "blanket agreement for purchased diagnostic tests" with their carrier when they begin to use their own urodynamic equipment. This agreement indicates to the carrier that you attest to using your own equipment, rather than using a third party's equipment this would require that additional information be reported such as acquisition cost and cost of supplies.