UCR 039: FAQs, Multiple ESWLs, 55700 with 96372, vital sign collection requirements, 99441-99443 usage, 51702 and A4344

February 19, 2021

Ray, Mark and Scott discuss questions from the Urology Coding and Reimbursement Group 

Question 1:  40 Seconds

Hello,  one of our physicians has been doing multiple ESWL's (cpt 50590) on the same dos for treating more than one stone..i.e one kidney stone, one ureteral stone or bilateral stones..i have found info that says only one 50590 per dos and also to unbundle with an X modifier
any clarification much appreciated

Question 2 - minute 5:03

We are seeing denials from Cigna Medicare plans where they are denying 96372 as bundled into 55700, 76872.   We added a modifier of 59 to 96372 to break it out of the bundling per the AUA coding today, since we are administering an antibiotic but the the insurance plan is stating it is part of the 55700 procedure.   As far as I know Medicare is not denying this.  Please advise.    Thanks for you help.   

Question 3 - minute 15:49

How important is it to check the vital signs on every patient for every office encounter? I understand the medical necessity and utility of it occasionally but is it at all essential to check the vital signs on every patient (or any patient for that matter) with the new 2021 E&M guidelines for documentation/billing purposes?

It is part of the physical exam so I think that it is not important at all for billing purposes.  Is that correct?

Question 4 - minute 21:55

Please clarify using 99441-99443 codes. We have a provider that wants to bill for these to call patients with test results which one of them has resulted in scheduling a surgical procedure. These calls are not scheduled as a telehealth visit would be. Please advise.
Thank you for all your help.

Question 5 - minute 26:48

When billing a private/commercial payer, can we bill codes 51702 and A4344 together?


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