Physician Coding - Office and Outpatient

How to Properly Code for the UroCuff Medical Device

Description of the UroCuff Test

• The UroCuff test measures urine flow and pressure without requiring a catheter.
• A cuff is applied externally, making the procedure less invasive and more comfortable for the patient.

Coding Options

 Primary Coding Option:

• 53899:
• This is an unlisted procedure code for the urinary system.
• Key Usage: Most providers are using this code to report the UroCuff test.

 Alternative Coding (When Applicable):

• 51728 with Modifier -52:
• This is used to report urodynamic studies, specifically a CMG (Cystometrogram) without full bladder voiding pressure.
• Modifier -52: Indicates a reduced service, as the full CMG is not performed.

 Post-Void Residual (PVR) Imaging Can be Billed if it Meets the Following Criteria:

• Be cautious when billing PVR imaging as part of the UroCuff or urodynamics:
  • PVR is only billable if it is medically necessary and well-documented.
  • Ensure the documentation states the PVR was done without catheterization and clearly supports the clinical need.
  • Denials are increasing for artificially filled bladder PVRs, especially from Aetna.
  • Best practice: Perform PVR before other tests like Urodynamics or UroCuff for accurate results.

Documentation Tips

•  Medical Necessity: Clearly explain why the PVR is required, especially when done in conjunction with the UroCuff test.
•  Timing:
  • Emphasize if the PVR was performed prior to Urodynamics for accurate results.
  • Document whether the PVR was done with a natural bladder fill versus an artificial fill.
• Avoid Denials: Explicitly state that the UroCuff test does not involve catheterization, and the PVR provides critical clinical data.

Key Considerations

• Denials from Aetna:
  • There is a recent trend of high-volume PVR denials (noted in Q4 2024).
  • Providers have successfully overturned denials by ensuring strong documentation of medical necessity and timing.
• Appeals: Be prepared to appeal PVR denials with detailed records.

Summary

• Use 53899 as the primary code for the UroCuff test.
• Consider 51728-52 if performing a partial CMG.
• Bill PVR imaging cautiously, ensuring documentation supports medical necessity.
• Stay vigilant with payers like Aetna and appeal denials when appropriate.

Proper coding and robust documentation can reduce denials and ensure appropriate reimbursement for the UroCuff procedure.