A statement in a recent "Coding Q&A" article discussing codes 52005 and 52332 was incorrect (Urology Times, January 2006, page 26).
A statement in a recent “Coding Q&A” article discussing codes 52005 and 52332 was incorrect (Urology Times, January 2006, page 26). The original text stated: “No modifier is needed for Medicare because the two are not bundled. However, if you were billing this to a patient with private insurance, I would apply the -51 modifier to the retrograde, which is the lesser of the two procedures.” This is simply wrong, as anyone can see by looking at the bundling edits, according to Ray Painter, MD, the article’s author.
Not only will you need a modifier, but you will still be denied payment and will have to appeal the denial to get payment. Dr. Painter apologizes for any confusion this may have caused.
Potential code for prior authorizations on AMA CPT Editorial Panel meeting agenda
March 28th 2024"Good public and economic policy must align costs, benefits, and incentives; currently, all costs are incurred by physician practices, and all financial savings and benefits from prior authorization accrue to health insurance plans, leading to perverse incentives,” says Alex Shteynshlyuger, MD.
How to code for removal of a bladder calculus via a Mitrofanoff
March 22nd 2024"Per CPT coding instructions, when procedures or services performed by physicians do not have a valid or descriptive CPT or Healthcare Common Procedure Coding System (HCPCS) code, the service should be reported using an unlisted code," write Jonathan Rubenstein, MD, and Mark Painter.