UCR 198: FAQs - Penile shockwave therapy billing; cystoscopy risk MDM, post-vasectomy semen analysis, and Trimix coding

June 7, 2024

Mark and Scott discuss FAQs that came into the PRS communities.  

1. Are you obligated to bill the new Category 3 CPT code for penile shockwave therapy, which we currently provide as a cash service? Specifically, do we have to use the Category 3 code when billing Medicare patients, even though there is no payment associated with it, and can we continue collecting cash without making it a Medicare billable service?
2. Is cystoscopy a moderate risk (level 4) procedure for medical decision making purposes absent other risk factors? Does it matter for MDM risk what discussion or thought process is documented? Or would that only be toward the medical necessity of the procedure?
3. CPT code 55250 says it is including postoperative semen examinations. So far we have done these in house but my physicians would like to no longer perform those and are currently looking into purchasing FELLOW kits to sell to the patients. We do not have any labs in town that perform post vas semen analysis. Any advice on what to do when patients refuse to purchase the kit?
4. If Trimix is a compounded drug wouldn't J7999 - Compounded drug, not otherwise classified be more appropriate to vs J3490?