Wiki billing 51725

[jcrahan13]

simple cystometrograms 51725 are being denied by Massshealth when billed with an E/M we have tried multiple different ways to bill it, have put a modifier 25 on the E/M and a 59 on the 51725 as the denial code is stating it is due to a modifier. What is the correct way to bill this? Also can a pvr be billed with 51725?

 

[thomas7331]

Per NCCI, the E/M codes are the column 2 code with 51725, so the modifier 25 on the E/M would be the correct way to bill. According to this bulletin from MassHealth, if it is still current, they follow NCCI rules, so they should not be denying this, unless they've adopted some new policy for this particular situation.

https://www.mass.gov/doc/all-provider-bulletin-227-modifier-coverage-and-national-correct-coding-initiative-ncci-updates/download

The post-void residual, CPT code 51798, does not have an NCCI relationship with 51725, so there shouldn't be an issue billing these together.

 

[liqgold2@aol.com]

Make sure when you do a simple cystometrogram you are using a spinal manometer to measure bladder pressures.

 

[liqgold2@aol.com]

Also for E/M-25 payment this must represent a significantand separate identifiable service from the 51725. Check on the diagnoses used for both services.