At this point, we see two possible coding pathways:
- Continue to report code 53852 (Transurethral destruction of prostate tissue; by radiofrequency thermotherapy).
- Report Rezum with unlisted code 53899 (Unlisted procedure, urinary system insert “Rezum Transurethral destruction of prostate tissue; by radiofrequency thermotherapy” or “Rezum water vapor or steam thermotherapy for destruction of prostate tissue”) in box 19 of the claim form to assure prompt payment.
You will need to consult your payer prior to providing this service to determine the correct approach for the payer and to make sure the service is covered. Consulting a payer should consist of reviewing current posted coverage policies and following instructions provided. If the coverage is unclear or there is no information posted, we recommend calling the payer for coverage and payment requirements.
Other points to consider:
- Payers may continue to request the use of code 53852 for ease of adjudication, or a payer may develop an edit on the unlisted code that allows processing of the service with the unlisted code without review of each claim.
- Payers may also choose to require the unlisted code and require a review of each case submitted.
- Payers may choose to consider Rezum as a non-covered service, allowing the practice to bill the patient directly for the service under the practice’s current fee schedule rate.
- If the payer does not provide any instructions or information on current coverage and/or proper reporting of Rezum, it is left to the practice to choose to continue to report code 53852 unless the AUA or the American Medical Association publishes a coding recommendation indicating otherwise, or to use 53899 as noted above.
Note: For payers that do not provide information on coverage or payment, remember that you will need to follow contractual instructions if contracted with the payer, which may or may not allow for collection of payment from the patient prior to claim adjudication, and likely will require appeal or submission of supporting materials for proper claim adjudication. For those payers with whom you are not contracted, collection from the patient is allowed; however, practice processes used for other services should be followed.
More from Urology Times:
Subscribe to Urology Times to get monthly news from the leading news source for urologists.