UCR 194: FAQs - MRI fusion biopsy update; physician onsite for pessary, urodynamics, biofeedback; and NCCI bundle, can you bill higher wRVU?

May 10, 2024

Mark and Scott discuss FAQs that came into the Urology Coding and Reimbursement Group.

1. MRI fusion biopsy update

2. Hi,  Can you please help us with the below questions.

   1. Pessary Insertion – does it require a physician to be onsite? What about Pessary cleaning?
   2. Urodynamics – we know that Medicare requires a physician to be onsite, does this also apply to commercial payers?
   3. Biofeedback - we know that Medicare requires a physician to be onsite, does this also apply to commercial payers?
      
      

3. Hi, a question regarding NCCI edit pls. When unbundling is not allowed between two CPT, due to an indicator "0", never billed together. If the secondary CPT has more work-RVU than primary CPT, i.e. 51705 (primary) wRVU 0.9; and 52000 (secondary) wRVU 1.53, Are there any rules that we must bill Primary 51705? VS Can we choose to bill 52000 instead, knowing that 52000 has more wRVU than 51705? Thank you.