UCR 176: FAQs - Can you bill simple prostatectomy and cystorrhaphy; Value for new pelvic exam code; Can you bill uroflow and/or PVR twice on same day; and can you bill voiding trial post-op after prostatectomy?

December 22, 2023

Mark, Ray, and Scott answer questions from the PRS Urology Coding Community:

1. I have multiple providers who want to bill 55867 & 51860 for the same procedure. While there’s isn’t an NCCI Edit for these codes, you can see that the procedure description includes both the making of an incision in the bladder wall and then later the suture repair. Coding guidelines dictate that since you could not perform the main surgical procedure without the minor one, then the minor is bundled into the major. As a coder I don't feel that there is support for separate reimbursement when the two codes are routinely billed together. Their contention is that there are 2 ways to do a simple prostatectomy. The first is through the capsule of the prostate gland without a bladder incision. The simple prostatectomy code has traditionally encompassed the first way of not making a bladder incision and if an incision was made then a cystorrhaphy was billed. With the addition of the new code specifically for the simple prostatectomy, I would like some direction on how these codes should be billed.
2. Have you been able to lookup what the reimbursement will be for the new CPT code 99459 for female pelvic exam?
3. Can 51741 and/or 51798 be billed twice on the same day?
   For example, if a patient does the first urofow and the volume is not adequate and then we have him drink and come back later for a second uroflow. 

4. When billing 51700 for voiding trial post-op after prostatectomy (90 day global), is a modifier needed ? Such as modifier 58