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Network www.prsnetwork.com Coding Conundrums 1. Network www.prsnetwork.com Copyright Acknowledgement CPT codes and descriptions are copyright© 2011 American.

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Presentation on theme: "Network www.prsnetwork.com Coding Conundrums 1. Network www.prsnetwork.com Copyright Acknowledgement CPT codes and descriptions are copyright© 2011 American."— Presentation transcript:

1 Network Coding Conundrums 1

2 Network Copyright Acknowledgement CPT codes and descriptions are copyright© 2011 American Medical Association. All rights reserved 2

3 Network Radiologic Documentation Image must be kept in chart Supervision and interpretation should be separately documented and found in patients chart CPT states, A written report signed by the interpreting physician should be considered an integral part of a radiologic procedure or interpretation. 3

4 Network Radiology Codes Imaging Used in the Urology Practice Fluoroscopy Fluoroscopy (separate procedure), up to 1 hour physician time, other than or (eg, cardiac fluoroscopy) Fluoroscopy, physician time, more than 1 hour, assisting a nonradiologic physician (eg, nephrostolithotomy, ERCP, bronchscopy, transbronchial biopsy) 4

5 Network Radiology Codes Post Void Residual Urine Measurement of post-voiding residual urine and/or bladder capacity by ultrasound; non-imaging 5

6 Network Radiology Codes Ultrasound Codes Abdomen Ultrasound, abdominal, B-scan and/or real time with image documentation; complete Ultrasound, abdominal, B-scan and/or real time with image documentation, limited (e.g., single organ, quadrant, follow-up) 6

7 Network Radiology Codes Ultrasound Codes Retroperitoneum Ultrasound, retroperitoneal (e.g., renal, aorta, nodes), B-scan and/or real time with image documentation; complete ***If clinical history suggests urinary tract pathology, complete evaluation of the kidneys and urinary bladder also comprises a complete retroperitoneal ultrasound Ultrasound, retroperitoneal (e.g., renal, aorta, nodes), B-scan and/or real time with image documentation; limited 7

8 Network Radiology Codes Ultrasound Codes Pelvis Ultrasound, pelvic (nonobstetric), B- scan and/or real time with image documentation; complete Ultrasound, pelvic (nonobstetric), B- Scan and/or real time with image documentation; limited or follow-up (e.g., for follicles) 8

9 Network Radiology Codes Computed Tomography (CT) Studies Computed tomography guidance for placement of radiation therapy fields (For placement of interstitial device(s) for radiation therapy guidance, prostate, use 55876) 9

10 Network Radiology Codes Dual energy X-ray absorptiometry (DXA), is a means of measuring bone mineral density (BMD). Two X-ray beams with differing energy levels are aimed at the patient's bones. When soft tissue absorption is subtracted out, the BMD can be determined from the absorption of each beam by bone. Dual energy X-ray absorptiometry is the most widely used and most thoroughly studied bone density measurement technology. 10

11 Network Radiology Codes Dual-energy X-ray Absorptiometry (DXA) Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; axial skeleton (eg, hips,pelvis,spine) appendicular skeleton (peripheral) (eg, radius, wrist, heel) vertebral fracture assessment (for dual energy x-ray absorptiometry [DXA] body composition study, use 76499) 11

12 Network Radiology Codes Brachytherapy Ultrasound, transrectal; prostate volume study for brachytherapy treatment planning (separate procedure) Ultrasonic guidance for interstitial radioelement application Placement Radioactive seeds 12

13 Network Fiducial Markers in an Office Placement of interstitial device(s) for radiation therapy guidance (eg, fiducial markers, dosimeter), prostate (via needle, any approach), single or multiple A4648 Tissue marker, implantable, any type, each Ultrasonic guidance for needle placement (e.g., Biopsy, aspiration injection, localization device), imaging supervision and interpretation Fluoroscopic guidance for needle placement(e.g., biopsy, aspiration, injection, localization device) Some carriers may bundle the fluoroscopic guidance 13

14 Network Fiducial Markers in an Office Implantable markers, A4648, should be reimbursed CPT states, Report supply of device separately. If you are receiving denials contact your Medicare Contractor AUA has created Gold Seed Marker appeal letter resources/reimbursement/appeal/goldseedmarkers.pdf 14

15 Network PNBx – Biopsy prostate Ultrasound, transrectal Ultrasonic guidance for needle placement (e.g., biopsy, aspiration, injection, localization device), imaging supervision and interpretation 15

16 Network PNBX Saturation Biopsy Biopsies, prostate, needle, transperineal, stereotactic template guided saturation sampling, including imaging guidance (Do not report in conjunction with 55700) – Transperineal approach only – Can only performed in hospital inpatient, hospital outpatient or ambulatory surgical setting(ASC) 16

17 Network PNBx G0416 Surgical pathology, gross and microscopic examination for prostate needle saturation biopsy sampling, 1-20 specimens G0417 Surgical pathology, gross and microscopic examination for prostate needle saturation biopsy sampling, specimens G0418 Surgical pathology, gross and microscopic examination for prostate needle saturation biopsy sampling, specimens G0419 Surgical pathology, gross and microscopic examination for prostate needle saturation biopsy sampling, greater than 60 specimens 17

18 Network Urodynamics Test Bill for all services - (select 1) Complex cystometrogram CMG; with urethral pressure profile studies (UPP) CMG; with voiding pressure studies(VP) CMG; with UPP & VP 36AUA Coding Seminar Series 2009

19 Network Urodynamics (cont) Complex uroflowmetry Electromyography studies (EMG) (other than needle) * intra-abdominal voiding pressure *(Add-on Code) Can add one or all 37

20 Network Fluoro/Videourodynamics (FUDS, VUDS) Urethrocystography, voiding, radiological supervision and interpretation Injection procedure for cystography or voiding urethrocystography

21 Network 38 Incident to Billing Urodynamics Urologist that performs test or is in the office when performed Charges -TC Urologist that interprets Charges -26

22 Network Incontinence Rx Pelvic Floor Rehabilitation – Biofeedback – electrical stimulation – PTNS (2011) – – Unattended code for electrical stimulation – may or may not pay – G0283 – unattended code for electrical stimulation - Medicare Caution – EMG Study baseline beginning and end – Functional testing (not recommended)

23 Network Interstim Test Stimulation (PNE Placement) Percutaneous implantation of neurostimulator electrodes sacral nerve (transforaminal placement) Incision for implantation of neurostimulator electrodes; sacral nerve (transforaminal placement) 23

24 Network InterStim Permanent SNS Implantation Incision for implantation of neurostimulator electrodes; sacral nerve (transforaminal placement) Insertion or replacement of peripheral neurostimulator pulse generator or receiver, direct or inductive coupling 24

25 Network InterStim Fluoroscopy Codes for SNS Implantation Fluoroscopy [separate procedure], up to 1 hour physician time OR Fluoroscopic guidance for needle placement (eg, biopsy, aspiration, injection, localization device) 25

26 Network Interstim Programming Electronic analysis of implanted neurostimulator pulse generator system (eg, rate, pulse amplitude and duration, configuration of wave form, battery status, electrode selectability, output modulation, cycling, impendence and patient compliance measurements); simple or complex brain, spinal cord, or peripheral (ie, cranial nerve, peripheral nerve, autonomic nerve, neuromuscular) neurostimulator pulse generator/transmitter, without programming simple spinal cord, or peripheral (ie, peripheral nerve, autonomic nerve, neuromuscular) neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming 26

27 Network InterStim Programming complex spinal cord, or peripheral (except cranial nerve) neurostimulator pulse generator /transmitter, with intraoperative or subsequent programming, first hour complex spinal cord, or peripheral (except cranial nerve) neurostimulator pulse generator/transmitter, with intraoperative or subsequent programming, each additional 30 minutes after first hour (List separately in addition to code for primary procedure) 27

28 Network InterStim Revision/Removal Revision or removal of peripheral neurostimulator electrodes Revision or removal of peripheral neurostimulator pulse generator or receiver 28

29 Network Other issues Laparoscopy, surgical prostatectomy, retropubic radical, including nerve sparing, includes robotic assistance, when performed Nodes(?) Laparoscopy, surgical; with bilateral total pelvic lymphadenectomy 29

30 Network Other issues TURBT, Fulguration, With Biopsy Fulguration, Minor, Small, Medium, Large Biopsy 30

31 Network Other issues Cystourethroscopy (separate procedure) vs Cystourethroscopy, with calibration and/or dilation of urethral stricture or stenosis, with or without meatotomy, with or without injection procedure for cystography, male or female 31

32 Network Other issues Multiple Stones Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with lithotripsy (ureteral catheterization is included) Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with removal or manipulation of calculus (ureteral catheterization is included) 32

33 Network Other issues Ileoscopy, through stoma; diagnostic, with or without collection of specimen(s) by brushing or washing (separate procedure) for the visualization of the conduit , Revision of ileostomy; simple (release of superficial scar) (separate procedure) or 44314, Revision of ileostomy; complicated (reconstruction in-depth) (separate procedure). 33

34 Network Other Issues Ileoscopy, through stoma; with transendoscopic stent placement (include predilation) for the ileal conduit 34

35 Network Other Issues Q2043 Sipuleucel-T, minimum of 50 million autologous CD54 + cells activated with PAP-GM-CSF, including leukapheresis and all other preparatory procedures, per infusion Intravenous infusion, for therapy, prophylaxis, or diagnosis (specify substance or drug); initial, up to 1 hour 35

36 Network Q and A


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