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UCR 146: FAQs - OPPS/ASC multiple procedures; discontinued procedure denial; No Surprises Act - new patient visit; stent placement for promoting healing billable?

May 26, 2023 

Mark, Ray, and Scott discuss 4 questions that came into the Urology Coding and Reimbursement Group.

1. I'm trying to understand the Multiple Procedure Payment Reduction (MPPR) rules for OPPS/ASC payments for endoscopic procedures. Do I use the standard 100%/50%/50% discounting rules for OPPS/ASC payments, or do I use the special rules that apply to the professional fees for endoscopic procedures?
2. InterStim Procedure Discontinued:
   Pt had an attempted Insertion of Interstim Procedure Stage 1 (INSERTION PERCUTANEOUS STIMULATOR ELECTRODE).  However, procedure was stopped because surgeon was unable to visualize the sacrum completely.  He did try and pass a needle in the area where the S3 foramen should have been but that was unsuccessful.  Procedure was stopped and all needles were removed.  
   
   Medicaid is denying 64561/53 stating they want the anatomical modifier, however I am unable to determine from the op notes what side he planned on placing the electrodes.
   
   After reviewing this I am now wondering if 64561/53 would even be correct since he did not truly start the procedure.
   
   I would love to know your thoughts on this.
3. No Surprises Act question: 
    
   Do we have to provide a good faith estimate for the new patient visit too?  Or just for higher dollar services like surgery?  
    
   So if a self-pay new patient comes in and there is no surgery or any other services needed just the new patient visit.  Do we need to provide this patient with a good faith estimate for the visit? 

4. Hi, 
   When ureteral surgery (pyeloplasty, ureteroureterostomy, etc) is performed and a stent is placed at the end of surgery to promote healing is it separately billable (52332)? or is this an inherent part of the surgery on the ureter? 
   I have conflicting resources but the most recent (2018) states it is not separately billed if placed in the same ureter to promote healing.  And if it was placed in the opposite ureter, for example for hydronephrosis, this might be a billable service? Thank you!

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