Overview
Urodynamics testing involves various diagnostic studies to assess bladder function and pressure dynamics.
Accurate coding and documentation are crucial for ensuring proper reimbursement and compliance with payer guidelines.
The primary challenge in urodynamics billing is selecting the correct CPT codes based on the level of testing performed, ensuring appropriate documentation, and avoiding unbundling errors.
Cystometrogram (CMG)
- Bladder Capacity: The amount of urine the bladder can hold before the urge to urinate occurs.
- Bladder Pressure: The pressure inside the bladder as it fills with fluid.
- Bladder Compliance: How easily the bladder expands as it fills with fluid.
- Detrusor Muscle Activity: The activity of the bladder muscle during filling and emptying.
- Bladder Sensation: When the patient feels the urge to urinate.
Urethral Pressure Profile (UPP)
Urethral pressure profile (UPP) is a urodynamic test that measures pressure along the urethra.
It helps assess the urethra's competence and length.
Uroflowmetry
Uroflowmetry is a non-invasive test that measures the speed and volume of urine flow.
It is used to assess the function of the lower urinary tract, including the bladder and urethra.
Cystometrogram (CMG)
There are four key Cystometrogram (CMG)βrelated codes based on complexity.
These codes are bundled, and only one may be billed per encounter:
- 51726 β CMG only
- 51727 β CMG + Urethral Pressure Profile (UPP)
- 51728 β CMG + Bladder Voiding Pressure
- 51729 β CMG + UPP + Bladder Voiding Pressure
Common Billing Patterns
- 51728 is frequently used for males with voiding dysfunction.
- 51729 is common in female patients or cases requiring incontinence diagnosis.
Additional Commonly Used Codes
- 51741 β Uroflowmetry
- 51784 β Electromyography (EMG)
- 51797 β Abdominal voiding pressure (add-on code)
- 51798 β Post-void residual (PVR)
- The test report from the urodynamics machine must support all billed services.
- The presence of Pabd (abdominal pressure) and Pves (bladder pressure) in the report helps justify 51797.
- UPP studies should have a dedicated section in the report or reference Valsalva/cough tests.
- An interpretation or summary of the results should be documented to support medical necessity.
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Many clinics perform urodynamics on a separate day from the evaluation, eliminating the need for Modifier -25.
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If performed on the same day with a 0-day global procedure, an E&M visit must be
separately identifiable to justify billing with Modifier -25.
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Ensure that 51729 is not incorrectly used for males when no UPP study is performed.
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The catheterization used in urodynamics testing is included in the service and should not be billed separately.
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Video urodynamics may include 51600 for contrast instillation and additional radiology codes.
On a 70-year-old Medicare patient, a ureteral lithotripsy of a 0.4 cm stone in the upper calyx of the right kidney was performed followed by ureteroscopy with basketing and removal of a fragment of the same stone. A ureteral stent was also inserted.
What is the correct billing of this encounter?
Answer: 52356
Procedures performed on a 66-year-old male with two separate calculi:
- Cystoscopy, right retrograde to confirm location of stones (52005)
- Ureteroscopy with basket removal of 3 stones β lower 1/3 right ureter (52352)
- Lithotripsy of a 0.7 cm stone β right renal pelvis (52353)
- Insertion of a right renal indwelling stent (52332)
Answer: 52356, 52352 -XS
Procedures performed on a Medicare patient:
- Manipulation and basket removal of a 0.3 cm stone in the lower 1/3 left ureter
- Ureteroscopy lithotripsy of a 0.4 cm stone in the upper calyx of the right kidney with insertion of an indwelling ureteral stent
What is the correct billing for this encounter?
Answer: 52356-LT, 52352-RT
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