UCR 016: FAQs - Consultation billing? Can you bill catheters and leg bags with 51702? Auditing rules for telehealth? PCNL - 50080/81 and -52?

July 31, 2020

Mark, Ray and Scott discuss answer and discuss questions asked on the Urology Coding and Reimbursement Group.


Can you bill a consultation (99245) when one of our providers is sending his pt to another provider in the same group to discuss doing a RALP.  Ins  plan UMR/UHC.   I don't think you can since they are under the same Tax ID #.   The provider that did the consult says you can for a non CMS plan.  Please advise.    Thanks

In the urology clinic setting when a patient comes in with urinary retention and we place a foley catheter to drain the bladder we code 51702 which, I believe, includes the actual cost of the catheter. Is that correct? Can we also bill for the leg bag or bedside drainage bag?
A4357 – Bedside Drainage Bag

The OIG will add to their work plan on August 3, 2020 two concurrent reviews of Medicare Parts B and C data to examine the use of telehealth services during the COVID-19 pandemic.  Report # OEI-02-20-00520.  Do you know if on August 3rd, when this is added to the work plan, if there will be more details of what will be audited?  Thanks, Tracy

We have a question regarding PCNL and access placement.  If a patient has a nephrostomy tube placed prior to the PCNL do we append modifier 52 to 50080/81?  We have been told since the access was already in place we would need to append modifier 52.  Also, if the same doctor performed the access can we bill 50432/33 and 50080/81 together and would 50080/81 still need a 52? 

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