Wiki Urodynamics inclusive to D&C?

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dan528i

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Hi, I'm having some issues with payment for a urodynamics claim.

The patient originally had a D&C (code 59812) performed at the hospital. Within the same month, the patient came into the doctor's office and had a urodynamics test done with the following billed codes:

51729: Cystometrogram W/Vp And U
51741-51: Complx Uroflowmetry
51784-51: Emg Anal/Ureth Sphincter-
51797: Voiding Press Studies; In

The insurance company denied payment for the urodynamics, stating that it's inclusive in the global payment for D&C. I sent in an appeal explaining that while the D&C was performed for an incomplete spontaneous abortion (diagnosis code 634.91), the patient's urodynamics were done for an unrelated issue, with a diagnosis of prolapse of the vaginal walls (diagnosis code 618.00). However, insurance is still denying urodynamics as inclusive to 59812.

I realize that D&C has a 90 day inclusive period, but this is a completely unrelated procedure.

Any help on how to code this to receive payment would be great.

Thanks!
 
Daniel, Urodynamics is definitely not a component or related to D& C at all on any account.
No way. They cannot include/ couple it with D& C. Oh my God, the anatomy and the body systems have to be reviewed to refresh their validation in doing so.
But one thing I could say: Why they could have denied is because you placed a diagnosis vaginal prolapse and vaginal prolapse as such do not justify the medical necessity. you know the insurance try to cut short as much as possible for you.
Your doctor cannot change the diagnosis, since it is already done but at least can definitely use additional code to identify the stress incontinence. If your doctor can add or place stress incontinence or mixed incontinence as the additional diagnosis( 625.6,788.3 or applicable 788.3x series) for this urodynamic, you are definitely to get it payed.
Vaginal Prolapse can only be a causation for the incontinence, which in turn makes the medical necessity for performing urodynamics; this intricacy those insurance people
may not/try not to understand to validate. So we have to definitely mention the incontinence as the reason for doing the Urodynamic study.
More over, you can very well see in your guide notes in the ICD_9 that you have to identify additional diagnosis of URINARY INCONTINENCE( FROM 625.6, 788.31,788.33 788.39).

SO THEY HAVE REASON TO REJECT. Please try to clarify with your doctor and substantiate the point of importance of addendum of urinary incontinence as the main symptom and encounter for performing urodynamics study.
Without the urinary symptom of incontinence and its documentation , the performance of urodynamics would not be validated and you would not be paid.
I hope it makes some sense. Thank you Dan
 
The solution to getting your claim paid might be in adding a modifier. I do agree with preserene about the additional dx, but the addition of a 79 modifier may also be required in order to get the insurance carrier to consider the claim.

Becky, CPC
 
Yes Becky, I agree. I thought of it but hither too, we need a new diagnosis for appending modifier 79.
Changing to the ew code, is it feasible at this stage having submitted once?
Thank you
 
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