Coding for urodynamics presents tough challenges

July 1, 2012

In a recent audit of urodynamics charges, Medicare recognized some codes but not others, and the documentation for all services that were reviewed only included the report from the urodynamics machine. This review pointed out the lack of understanding of these codes by payers and physicians.

Q Urodynamics continues to be a tremendous challenge for our coders. Can you provide information on what is expected in terms of documentation to identify the actual study components performed? What would an auditor be looking for (graphs and summary report, interpretation, procedure write-up by the tech)? Common practice for our group is to have the studies performed on a separate date by a tech, with a future reading/interpretation by the physician. Is correct practice to split these services in this case? Should there also be a brief procedure description by the tech when the studies are performed?

As far as split billing, it is accurate to report the services provided on the date the service was actually provided. Therefore, your circumstance where the technical component is provided on a different day than the procedural component should be billed as technical component on the day performed (code with modifier –TC) and professional component on the day read (code with modifier –26) on a different day. If the payer requires global billing (billing of the codes with no modifier), we recommend you obtain that directive from the payer in writing.