UCR 131: FAQs: New PCNL, urodynamics clinical denial

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UCR 131: FAQs: New PCNL code clarification, urodynamics clinical denial, 0421T (Transurethral waterjet ablation of prostate) valuation and -22 usage, and outside CT and Category 2 E/M Data

February 3, 2023

Mark, Ray, and Scott discuss questions and current topics.

CODE 50081 - Our providers are interpreting the use of imaging guidance i.e. fluoroscopy to create the tract and imaging guidance to remove the stones. Not for the imaging to position of the neph tube at the end of the case - Can you confirm?
Establishing access with PCNL procedure was discussed and CPT codes 50436/50437 were suggested to report for the access created with PCNL when Urologist performs this. However, I have seen AUGS guidance which suggests 50432-52 (since tube is include in PCNL) would be appropriate to report when access is created by Urologist for PCNL procedure. Which is correct? 50436/37 state "existing tract" in CPT verbiage which is confusing.
Urodynamics:
I have a denial from the insurance company for 51741. They are stating that they are following the International Incontinence Society guidelines that the pressure flow void volume should be >150ml. Not sure on where this information is from. I did not think that it had to meet certain standards.
Does anyone have guidance on the billing pricing for 0421T? Medicare doesn't have a fee schedule, but that doesn't mean they won't pay it if billed.
Thanks for your help!
Can I bill CPT 0421T with the modifier 22 if supported in medical records?
So, if our physician(s) orders the CT, but it is performed at an outside entity, would they be able to count the review and interpretation of that CT? Also, if the ordering physician does review and interpret the CT, then refers the patient to one of their partners for a procedure/surgery and that physician documents they have reviewed and interpreted, who or how would that be counted?