UCR 026: PHE Extension Update; FAQs: Urology Coding and Reimbursement

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UCR 026: PHE Extension; FAQs - Urology Coding and Reimbursement Group

October 21, 2020

Mark gives an update on the status of the Public Health Emergency (PHE). Mark, Ray, and Scott discuss FAQs:

In my office we just started using a stent snare to remove stents at our office based surgery. We would utilize the code

50386 – Removal (via snare/ capture) of internally dwelling ureteral stent via transurethral approach, without use of cystoscopy, including radiological supervision and interpretation.

We are able to use ultrasound at the time of the procedure to confirm adequate grasp and stent removal, but have not done so routinely.

However, we do not use sedation for this.

I have recently heard from another doctor that this code is only billed when a doctor does a stent removal using a snare using both radiologic guidance and sedation. I don't see any reference to sedation in the description, or any necessity to use imaging guidance, only the possibility to do so.

How can we do this procedure and bill for it correctly?
Does anyone know what the CPT code is for the i-Tind procedure for BPH? One of our providers is going start doing these. I was thinking of 53855 for the placement and 52310 for the removal. Any suggestions?
Thanks
Can you code a consultation visit (non Medicare) for new patient office visit seen in the ER and told to follow up with urology?
I need some additional clarification on the 25 modifier. What are some examples of when this would be inappropriate? I listened to the podcast and got a lot of good info on when it is appropriate but need inappropriate scenarios. Some examples we are seeing are injectables like Lupron , Xgeva, Firmagon and installation procedures like BCG. Xgeva and Firmagon are seen on a monthly basis. Is it appropriate to bill an office visit with a 25 for these? The Lupron is usually administered every 6 months and this would also have lab work done too. Is it ok to bill this since the patient was seen 6 months ago? Can you go over using the 25 modifier with injections.