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urodynamic testing coding

Super Posted Mon 20th of December, 2010 16:22:34 PM

Trying to understand the best way to code for 51728-51741 to receive maximum reimbursement

SuperCoder Answered Mon 20th of December, 2010 22:48:01 PM

In a simple CMG (51725, Simple cystometrogram [e.g., spinal manometer]), the urologist places a small catheter in the bladder, fills the bladder by gravity, and measures capacity and storage pressures by making use of a spinal manometer. A complex CMG ((51726, Complex cystometrogram [e.g., calibrated electronic equipment]) covers filling the bladder through a catheter and measuring the pressures with calibrated electronic equipment. If your urologist carries out a urethral pressure profile (UPP), go for 51727 (Complex cystometrogram [i.e., calibrated electronic equipment]; with urethral pressure profile studies [i.e., urethral closure pressure profile], any technique). For a complex CMG with voiding pressure study, go for 51728 (… with voiding pressure studies [i.e, bladder voiding pressure], any technique) For a complex CMG with voiding pressure study and UPP, report 51729 (with voiding pressure studies [i.e., bladder voiding pressure] and urethral pressure profile studies [ie, urethral closure pressure profile], any technique). During a simple UFR (51736, Simple uroflowmetry [e.g., stopwatch flow rate, mechanical uroflowmeter]), the urologist keeps an eye on the urine flow, sometimes making use of a stopwatch to measure the flow. A complex UFR (51741, Complex uroflowmetry [e.g., calibrated electronic equipment]) uses special electronic equipment to measure the flow of urine. EMG studies (51784, Electromyography studies of anal or urethral sphincter, other than needle, any technique), in which the urologist places skin patch electrodes on the perineum to measure electrical and muscular activity of the perineal muscles and urinary sphincter. A needle EMG (51785, Needle electromyography studies of anal or urethral sphincter, any technique) covers placing needles into the pelvic floor to measure muscle activity while bladder filling and at rest. These days few urologists use needle needle electromyography. Stimulus evoked response (51792, Stimulus evoked response [e.g., measurement of bulbocavernosus reflex latency time]) encompasses stimulating the sacral arch via the glans or clitoris and measuring motor activity in the pelvic floor urethral sphincter. This test is rarely performed by urologists. VP studies (+51797, Voiding pressure studies, intra-abdominal [i.e., rectal, gastric, intraperitoneal] [List separately in addition to code for primary procedure]) measure specific pressures during coding. This is an add-on code that can't be billed independently. You can bill with 51728 or 51729. Valsalva (abdominal) leak point pressure: The urologist queries the patients to bear down forcefully (Valsalva maneuver) while he observes the abdominal pressure at which leakage occurs from the bladder at the urethral meatus (around the urethral catheter) when the bladder's been filled with a minimum of 150 cc of fluid. The bladder pressure leakage is known as the leak point pressure. This is now covered in 51727 and 51729.

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