Urodynamics: Accurate billing may up reimbursement

April 1, 2009

In reviewing the data for multiple urology practices, the PRS Urology Data Initiative has shown that correctly billing for urodynamics has provided an immediate increase in income without adding new patients.

Here's a look at all aspects of urodynamics billing and the correct way to report services provided.

If you own urodynamics equipment and perform urodynamics in your office, you should bill for any or all of the following tests performed:

• 51726: Complex cystometrogram (eg, calibrated electronic equipment)

• 51741: Complex uroflowmetry (eg, calibrated electronic equipment)

• 51772: Urethral pressure profile studies (urethral closure pressure profile), any technique

• 51784: Electromyography studies of anal or urethral sphincter, other than needle, any technique

• 51795: Voiding pressure studies; bladder voiding pressure, any technique

• 51797: Voiding pressure studies; intra-abdominal voiding pressure (AP) (rectal, gastric, intraperitoneal) (List separately in addition to code for primary procedure.)

How you report the codes depends on how the services are performed in the course of treatment in your office.

'Incident to' rules

Every procedure in the office is billed as if a qualified provider (the urologist, a physician assistant, or nurse practitioner) provided the service. Therefore, the nurse (or technician) who performs a test is not reimbursed; the service is instead charged as an "incident to" service by the qualified provider who is immediately available and in the office at the time of the procedure.

Services on same day by same provider

If you provide both the testing and professional interpretation of the urodynamics test on the same date, the correct reporting is:

• 51726

• 51795–51

• 51772–51

• 51784–51

• 51741–51

• 51797 (add-on procedure does not require –51).

Note that for Medicare, modifier –51 is not required, but the order on the bill should be listed as above.