Wiki UroCuff

[awyche0603@yahoo.com]

How is everyone billing for Urocuff? Are you using modifier 52 on code 51728; if so why? What part of code 51728 is not being done when doing Urocuff?

 

[daniel]

Clarification: Coding for a Voiding Pressure Study using a Penile Cuff​

By Policy and Advocacy Brief posted 05-03-2017 11:42​

https://community.auanet.org/blogs/policy-brief/2017/05/03/clarification-coding-for-a-voiding-pressure-study-using-a-penile-cuff#:~:text=Since%20there%20is%20no%20CPT,then%20all%20can%20be%20reported.

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There has been some confusion by members for reporting a voiding pressure study using the penile cuff. At this time, there is no CPT code available to report a pressure study using the penile cuff. As stated in our previous article in the Brief, the Coding and Reimbursement Committee (CRC) reviewed the reporting of the penile cuff for a voiding pressure study in male patients.
The penile cuff is a non-invasive diagnostic test for male urinary disorders, also known as lower urinary tract symptoms (LUTS). The test uses an external penile cuff (resembling a blood pressure cuff) to measure bladder pressure while also calculating your flow rate.
The CRC supports the use of CPT code 51741 Complex uroflowmetry (e.g., calibrated electronic equipment) and CPT code 51784 Electromyography studies (EMG) of anal or urethral sphincter, other than needle, any technique when the uroflow and EMG when performed and documented. However, the CRC determined that 51728 Complex cystometrogram (i.e., calibrated electronic equipment); with voiding pressure studies (i.e., bladder voiding pressure), any technique with the modifier 52 Reduced Services is not appropriate to report the voiding pressure study. Since there is no CPT code available to report a pressure study using the penile cuff, use CPT code 53899 Unlisted procedure, urinary system to report the pressure study when performed and documented. If all three procedures are performed and documented, then all can be reported. The use of the modifier 51 Multiple procedures may be necessary when reporting these three procedures on the same claim submission. Check with your specific insurer to determine if this modifier is necessary.

 

[mary.radtke@auihealth.com]

If the patients Physician who orders the Urocuff study is not present in the office the day of the test, do we bill under the Physician who is in the office that day. If so, then that physician in the office would have to sign the urocuff study report and appointment showing them as the Provider?

 

[csperoni]

I am not familiar with the specifics of the "urocuff" study, but most procedures performed by ancillary staff require direct supervision by a physician. The billing provider must be the one providing direct supervision, even if not the physician who ordered the test.
AUGS has a good article about coding urodynamic studies and specifies this:
Coding Pitfalls:
Urodynamics can be performed by non-physician practitioners such as physician assistants, nurse, or medical technician. However, billing for these services requires direct supervision, which means that the billing physician must be present in the office when that individual performs the urodynamics.