Physician Coding - Office and Outpatient

How to Properly Code for the UroCuff Medical Device

Description of the UroCuff Test

• The UroCuff test measures urine flow and pressure without requiring a catheter.
• A cuff is applied externally, making the procedure less invasive and more comfortable for the patient.

Coding Options*

 Primary Coding Option:

53899: This is an unlisted procedure code for the urinary system.

Key Usage: Most providers are using this code to report the UroCuff test.

 Alternative Coding (When Applicable):

51728 with Modifier -52: This is used to report urodynamic studies, specifically a CMG (Cystometrogram) without full bladder voiding pressure.

Modifier -52: Indicates a reduced service, as the full CMG is not performed.

*Always verify coding and billing guidelines with your specific payer, as policies and coverage determinations can vary by insurer and are subject to change.

 Post-Void Residual (PVR) Imaging Can be Billed if it Meets the Following Criteria:

Be cautious when billing PVR imaging as part of the UroCuff or urodynamics:

• PVR is only billable if it is medically necessary and well-documented.
• Ensure the documentation states the PVR was done without catheterization and clearly supports the clinical need.
• Denials are increasing for artificially filled bladder PVRs, especially from Aetna.
• Best practice: Perform PVR before other tests like Urodynamics or UroCuff for accurate results.

Documentation Tips

•  Medical Necessity: Clearly explain why the PVR is required, especially when done in conjunction with the UroCuff test.
•  Timing:
  • Emphasize if the PVR was performed prior to Urodynamics for accurate results.
  • Document whether the PVR was done with a natural bladder fill versus an artificial fill.
• Avoid Denials: Explicitly state that the UroCuff test does not involve catheterization, and the PVR provides critical clinical data.

Key Considerations

• Denials from Aetna:
  • There is a recent trend of high-volume PVR denials (noted in Q4 2024).
  • Providers have successfully overturned denials by ensuring strong documentation of medical necessity and timing.
• Appeals: Be prepared to appeal PVR denials with detailed records.

Additional Support Resources

Sample Claim Submission Letter: 51728 -52

Sample Claim Submission Letter: 53899

Non-invasive Summary of Supporting Evidence

2020 UroCuff Study

Sample Publication on Equivalence to Catheterized Voiding Pressure

Sample Predictor of BPH Procedures - 1

Sample Predictor of BPH Procedures - 2

Sample Appeal Letter: 51728 -52

Sample Appeal Letter: 53899

A Physician Dictation for UroCuff

Principles of the UroCuff Test

Summary of Supporting Evidence

SRS Coding Hotline
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