Network Coding Conundrums 1. Network Copyright Acknowledgement CPT codes and descriptions are...

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Coding Conundrums

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Copyright Acknowledgement

• CPT codes and descriptions are copyright© 2011 American Medical Association. All rights reserved

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Radiologic Documentation

• Image must be kept in chart • Supervision and interpretation

should be separately documented and found in patient’s chartCPT states, “A written report signed by the interpreting physician should be considered an integral part of a radiologic procedure or interpretation.”

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Radiology Codes

Imaging Used in the Urology PracticeFluoroscopy76000 Fluoroscopy (separate procedure),

up to 1 hour physician time, other than 71023 or 71034 (eg, cardiac fluoroscopy)

76001 Fluoroscopy, physician time, more than 1 hour, assisting a nonradiologic physician (eg, nephrostolithotomy, ERCP, bronchscopy, transbronchial biopsy)

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Radiology Codes

Post Void Residual Urine51798 Measurement of post-

voiding residual urine and/or bladder capacity by ultrasound; non-imaging

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Radiology Codes

Ultrasound CodesAbdomen 76700 Ultrasound, abdominal, B-scan

and/or real time with image documentation; complete

76705 Ultrasound, abdominal, B-scan and/or real time with image documentation, limited (e.g., single organ, quadrant, follow-up)

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Radiology Codes

Ultrasound CodesRetroperitoneum 76770 Ultrasound, retroperitoneal (e.g.,

renal, aorta, nodes), B-scan and/or real time with image documentation; complete

***If clinical history suggests urinary tract pathology, complete evaluation of the kidneys and urinary bladder also comprises a complete retroperitoneal ultrasound.

76775 Ultrasound, retroperitoneal (e.g., renal, aorta, nodes), B-scan and/or real time with image documentation; limited

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Radiology Codes

Ultrasound CodesPelvis 76856 Ultrasound, pelvic (nonobstetric),

B-scan and/or real time with image documentation; complete

76857 Ultrasound, pelvic (nonobstetric), B-Scan and/or real time with image documentation; limited or follow-up (e.g., for follicles)

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Radiology Codes

Computed Tomography (CT) Studies

77014 Computed tomography guidance for placement of radiation therapy fields(For placement of interstitial device(s) for radiation therapy guidance, prostate, use 55876)

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Radiology Codes

Dual energy X-ray absorptiometry (DXA), is a means of measuring bone mineral density (BMD). Two X-ray beams with differing energy levels are aimed at the patient's bones. When soft tissue absorption is subtracted out, the BMD can be determined from the absorption of each beam by bone. Dual energy X-ray absorptiometry is the most widely used and most thoroughly studied bone density measurement technology.

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Radiology Codes

Dual-energy X-ray Absorptiometry (DXA)• 77080 Dual-energy X-ray absorptiometry

(DXA), bone density study, 1 or more sites; axial skeleton (eg, hips,pelvis,spine)

• 77081 appendicular skeleton (peripheral) (eg, radius, wrist, heel)

• 77082 vertebral fracture assessment(for dual energy x-ray absorptiometry

[DXA] body composition study, use 76499)

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Radiology Codes

Brachytherapy 76873 Ultrasound, transrectal; prostate

volume study for brachytherapy treatment planning (separate procedure)

76965 Ultrasonic guidance for interstitial radioelement application

55875 Placement Radioactive seeds

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Fiducial Markers in an Office

• 55876 Placement of interstitial device(s) for radiation therapy guidance (eg, fiducial markers, dosimeter), prostate (via needle, any approach), single or multiple

• A4648 Tissue marker, implantable, any type, each

• 76942 Ultrasonic guidance for needle placement (e.g., Biopsy, aspiration injection, localization device), imaging supervision and interpretation

• 77002 Fluoroscopic guidance for needle placement(e.g., biopsy, aspiration, injection, localization device) Some carriers may bundle the fluoroscopic guidance

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Fiducial Markers in an Office

• Implantable markers, A4648, should be reimbursed

• CPT states, “Report supply of device separately.”

• If you are receiving denials contact your Medicare Contractor

• AUA has created Gold Seed Marker appeal letterhttp://www.auanet.org/content/practice-resources/reimbursement/appeal/goldseedmarkers.pdf

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PNBx

55700 – Biopsy prostate

76872 Ultrasound, transrectal

76942 Ultrasonic guidance for needle placement (e.g., biopsy, aspiration, injection, localization device), imaging supervision and interpretation

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PNBX

Saturation Biopsy55706 Biopsies, prostate, needle,

transperineal, stereotactic template guided saturation sampling, including imaging guidance(Do not report 55706 in conjunction with 55700)– Transperineal approach only– Can only performed in hospital inpatient,

hospital outpatient or ambulatory surgical setting(ASC)

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PNBx

• G0416 Surgical pathology, gross and microscopic examination for prostate needle saturation biopsy sampling, 1-20 specimens



• G0419 Surgical pathology, gross and microscopic examination for prostate needle saturation biopsy sampling, greater than 60 specimens

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Urodynamics Test

Bill for all services - (select 1)• 51726 Complex cystometrogram• 51727 CMG; with urethral pressure

profile studies(UPP)• 51728 CMG; with voiding pressure

studies(VP)• 51729 CMG; with UPP & VP

36AUA Coding Seminar Series 2009


Urodynamics (con’t)• 51741 Complex uroflowmetry • 51784 Electromyography studies

(EMG) (other than needle)• 51797 * intra-abdominal voiding

pressure *(Add-on Code)

Can add one or all

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Fluoro/Videourodynamics (FUDS, VUDS)

74455 -Urethrocystography, voiding, radiological supervision and

interpretation 51600 -Injection procedure for cystography or voiding urethrocystography

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“Incident” to BillingUrodynamics

• Urologist that performs test or is in the office when performed

Charges -TC • Urologist that interprets

Charges -26


Incontinence Rx• Pelvic Floor Rehabilitation

– 90911 Biofeedback– 90732 electrical stimulation

– 64566 PTNS (2011) – 97014 – Unattended code for electrical stimulation –

may or may not pay– G0283 – unattended code for electrical stimulation -

Medicare

Caution– 51784 EMG Study baseline beginning and end– 97750 Functional testing (not recommended)


Interstim

Test Stimulation (PNE Placement)

• 64561 Percutaneous implantation of neurostimulator electrodes sacral nerve (transforaminal placement)

• 64581 Incision for implantation of neurostimulator electrodes; sacral nerve (transforaminal placement)

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InterStim

Permanent SNS Implantation

• 64581 Incision for implantation of neurostimulator electrodes; sacral nerve (transforaminal placement)

• 64590 Insertion or replacement of peripheral neurostimulator pulse generator or receiver, direct or inductive coupling

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InterStim

Fluoroscopy Codes for SNS Implantation

• 76000 Fluoroscopy [separate procedure], up to 1 hour physician time

OR• 77002 Fluoroscopic guidance for

needle placement (eg, biopsy, aspiration, injection, localization device)

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Interstim

Programming95970 Electronic analysis of implanted neurostimulator

pulse generator system (eg, rate, pulse amplitude and duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impendence and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, autonomic nerve, neuromuscular) neurostimulator pulse generator/transmitter, without programming

95971 simple spinal cord, or peripheral (ie, peripheral nerve, autonomic nerve, neuromuscular) neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming

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InterStim

Programming

95972 complex spinal cord, or peripheral (except cranial nerve) neurostimulator pulse generator /transmitter, with intraoperative or subsequent programming, first hour

95973 complex spinal cord, or peripheral (except cranial nerve) neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure)

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InterStim

Revision/Removal

• 64585 Revision or removal of peripheral neurostimulator electrodes

• 64595 Revision or removal of peripheral neurostimulator pulse generator or receiver

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Other issues

• 55866 Laparoscopy, surgical prostatectomy, retropubic radical, including nerve sparing, includes robotic assistance, when performed

• Nodes(?) • 38571 Laparoscopy, surgical; with

bilateral total pelvic lymphadenectomy

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Other issues

• TURBT, Fulguration, With Biopsy• 52214 Fulguration, 52224 Minor,

52234 Small , 52235 Medium, 52240 Large

• 52204 Biopsy

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Other issues

• 52000 Cystourethroscopy (separate procedure)

vs. • 55281 Cystourethroscopy, with

calibration and/or dilation of urethral stricture or stenosis, with or without meatotomy, with or without injection procedure for cystography, male or female

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Other issues

• Multiple Stones• 52353 Cystourethroscopy, with

ureteroscopy and/or pyeloscopy; with lithotripsy (ureteral catheterization is included)

• 52352 Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with removal or manipulation of calculus (ureteral catheterization is included)

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Other issues

• 44380 Ileoscopy, through stoma; diagnostic, with or without collection of specimen(s) by brushing or washing (separate procedure) for the visualization of the conduit.

• 44312, Revision of ileostomy; simple (release of superficial scar) (separate procedure) or 44314, Revision of ileostomy; complicated (reconstruction in-depth) (separate procedure).

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Other Issues

• 44383 Ileoscopy, through stoma; with transendoscopic stent placement (include predilation) for the ileal conduit

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Other Issues

• Q2043 Sipuleucel-T, minimum of 50 million autologous CD54+ cells activated with PAP-GM-CSF, including leukapheresis and all other preparatory procedures, per infusion

• 96365 Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); initial, up to 1 hour

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