Urodynamic testing - Handy cheat sheet info (CMG, Uroflow)

Giving Credit, where Credit is due....  This is a GREAT cheat sheet for keeping the urodynamics coding
information clear, when coding for Cystometrogram and Uroflow procedures. --  Thanks are extended to Dr. Michael Ferragamo... 


When your urologist says he performed urodynamics tests, you need to dig deeper into his documentation for clues about which code to report. Tack this overview up by your computer to help you quickly choose the right code every time.

• In a simple CMG (51725, Simple cystometrogram [e.g., spinal manometer]), the urologist places a small catheter in the bladder, fills the bladder by gravity, and measures capacity and storage pressures using a spinal manometer.

• A complex CMG (51726, Complex cystometrogram [e.g., calibrated electronic equipment]) involves filling the bladder through a catheter and measuring the pressures with calibrated electronic equipment. If your urologist also performs a urethral pressure profile (UPP), report 51727 (Complex cystometrogram [i.e., calibrated electronic equipment]; with urethral pressure profile studies [i.e., urethral closure pressure profile], any technique). For a complex CMG with voiding pressure study, report 51728 (… with voiding pressure studies [i.e., bladder voiding pressure], any technique).

For a complex CMG with voiding pressure study and UPP, use 51729 (… with voiding pressure studies [i.e., bladder voiding pressure] and urethral pressure profile studies [ie, urethral closure pressure profile], any technique).

• During a simple UFR (51736, Simple uroflowmetry [e.g., stopwatch flow rate, mechanical uroflowmeter]), the urologist visually observes the urine flow, sometimes using a stopwatch to gauge and measure the flow.

• A complex UFR (51741, Complex uroflowmetry [e.g., calibrated electronic equipment]) makes use of special electronic equipment to measure the urine flow.

• EMG studies (51784, Electromyography studies of anal or urethral sphincter, other than needle, any technique), in which the urologist places skin patch electrodes on the perineum to measure electrical and muscular activity of the perineal muscles and urinary sphincter.

• A needle EMG (51785, Needle electromyography studies of anal or urethral sphincter, any technique) involves placing needles into the pelvic floor to measure muscle activity during bladder filling and at rest. Few urologists use needle electromyography these days.

• Stimulus evoked response (51792, Stimulus evoked response [e.g., measurement of bulbocavernosus reflex latency time]) involves stimulating the sacral arch via the glans or clitoris and measuring motor activity in the pelvic floor or urethral sphincter. Urologists rarely perform this test.

• VP studies (+51797, Voiding pressure studies, intra-abdominal [i.e., rectal, gastric, intraperitoneal] [List separately in addition to code for primary procedure]) measure specific pressures during oiding. This is an add-on code that cannot be independently billed. You can bill is with 51728 or 51729.

• Valsalva (abdominal) leak point pressure: The urologist asks the patient to bear down forcefully (Valsalva maneuver) while he observes the abdominal pressure at which leakage occurs from the bladder at the urethral meatus (around the urethral catheter) when the bladder has been filled with a minimum of 150 cc of fluid. The bladder pressure at leakage is called the leak point pressure. This is now included in 51727 and 51729

5010 deadline -

Version 5010 Enforcement Discretion Period Ends on June 30, 2012.   cms.hhs.gov

The deadline for all HIPAA-covered entities to upgrade to Version 5010 electronic standards was January 1, 2012. However, the Centers for Medicare and Medicaid Services (CMS) initiated an enforcement discretion period until June 30, 2012 to give the industry additional time to complete testing. CMS made this decision based on industry feedback that many organizations and their trading partners were not yet ready to finalize system upgrades for this transition.

If you have not yet finalized your Version 5010 upgrade, you should be working to complete this step as soon as possible!

Version 5010 Resources
CMS is committed to helping you successfully upgrade to Version 5010 and ICD-10 by providing resources on the CMS ICD-10 website to help you understand and manage your upgrade.

CMS regularly updates the CMS ICD-10 website, including a web page dedicated to Version 5010 information and resources.

CMS has also posted a fact sheet, which discusses steps providers should be taking now to be compliant with the upgrade to Version 5010 by June 30, 2012.

If you are looking to find good ICD-10 information, or training, check out what I have to offer, as I am an AHIMA certified ICD-10 cm/pcs trainer.  In addition, please check out the educational information available with some of my great clients and resources at AHIMA, AAPC, justcoding.com and codingcert.com.  Check out the link and access my free 30 minute webinar related to ICD-10 training strategies...  Free is good!!!!   http://www.codingcert.com/news/free-webinar-icd-10-status-update-whats-next-transition-training-strategies/

L  : )

Rho(D) aka (Rhogam) coding quandry: Two ways to code, both are correct!

It's hard to believe, but in pregnancy Rhogam administration, there are actually two correct methods to code the administration of the Rho(D) globulin serum.  As a coder, it is up to you to determine how best to accomplish this for your OB/GYN practice.  I've outlined below what you need to know to correctly code, bill and get reimbursement for this service. 

History of Rho(D)

RHo(D) Immune globulin is the serum globulin extracted from human blood, or can also be a recombinant immune globulin product that has been created through genetic manipulation of human and/or animal protein.  RH plays an important role in the pregnant patient and the developing fetus. 

Rh blood types were discovered back in 1940, and over the last 70 years researchers have learned a lot about the genetic complexities of Rh and blood typing in relationship to fetal and maternal well being.  The Rh system was initially named after rhesus monkey, since they were the initial research subjects. (and also since the rhesus monkey blood bears similar human qualities).  What was determined in these studies is that when creating the antiserum – if the antiserum agglutinates the red cells you are considered and Rh+(positive) and if it does not you are considered an Rh-(negative). 

From a clinical standpoint, the Rh factor of positive and negative can lead to problems between a mother and the developing fetus.  It is referred to as mother-fetus incompatibility, and occurs when the mother is Rh-(negative) and the fetus is Rh+(positive).  Amazingly enough, these antibodies can cross the placenta and destroy fetal red blood cells.  The risk for this happening increases with each pregnancy.

To help prevent these complications during pregnancy,  physicians routinely order the pregnant patient to undergo testing to determine the Rh and ABO blood typing.  Once this has been completed, the physician will then determine if having the patient receive the Rho(D) immune globulin. 

According to the American College of Obstetricians and Gynecologists (ACOG) they have developed a standard guideline of re administration of the Rho(D) immune globulin product

These standards are:

• The first dose of Rho(D) immune globulin is to be given at 28 weeks’ gestation (earlier if there’s been an invasive event),
• Followed by a postpartum dose given within 72 hours of delivery.

The Two Coding Scenario's 

As a coder, you need to understand the documentation requirements for the administration of a Rho(D) immune globulin, and then how to bill and code for it appropriately.  This is where the coding of the product becomes somewhat complex. 

CPT identifies the Rho(D) immune globulin serum with these three codes

• 90384 Rho(D) immune globulin (RhIg), human, full-dose, for intramuscular use
• 90385 Rho(D) immune globulin (RhIg), human, mini-dose, for intramuscular use
• 90386 Rho(D) immune globulin (RhIgIV), human, for intravenous use

To code and bill the serum itself, CPT also directs us to report the administration of the serum with codes 96365-96368, 96372, 96374 or 96375 as appropriate.  CPT also instructs us that modifier 51 should not be appended when performed with another procedure.

However, CMS (Center for Medicare & Medicaid Services) the part B physician fee schedule does not recognize the coding or payment for the codes 90384, 90385 and 90386.  CMS does however recognize the HCPCS codes for Rho(D) as shown below.

• J2788 Injection, Rho D immune globulin, human, minidose, 50 mcg (250 i.u.)
• J2790 Injection, Rho D immune globulin, human, full dose, 300 mcg (1500 i.u.)
•  J2791 Injection, Rho D immune globulin (human), (Rhophylac), intramuscular or intravenous,100 IU
• J2792 Injection, Rho D immune globulin, intravenous, human, solvent detergent, 100 IU

If you choose to bill the HCPCS codes J2788—J2792, again you will need to code and bill for the injection of the serum with either the CPT code(s) 96365-96368, 96372, 96374 or 96375 as appropriate, or with the ICD-9 Volume 3 procedure code of 99.11

This creates the issue where both methods of coding are correct.  The issue then falls upon the coder to determine how to code the service based upon how the 3^rd party payer will reimburse for the service. 

The next issue with the coding of Rho(D) in pregnancy is determining the correct diagnosis to be appended with the service rendered.  The most common diagnoses for a pregnant patient with the need for a Rho(D) are:  

V07.2          Need for prophylactic immunotherapy

V22.1          Supervision of other normal pregnancy

656.10                  Rhesus isoimmunization unspecified as to episode of care in pregnancy

656.11                   Rhesus isoimmunization affecting management of mother, delivered

656.13         Rhesus isoimmunization affecting management of mother, antepartum condition

However, there are many other pregnancy diagnoses that would denote the need for a Rho(D) injection.  The diagnosis needs to be clearly documented by the provider for the coder to accurately code and bill for the procedure.

As with any and all services, it is recommended that you pre-authorize the Rho(D) injection first with the insurance carrier/3^rd party payer.  When pre-authorizing, inquire with the carrier how they would like to see the service coded.  This will help you code and bill for this correctly up-front, and avoid payment and coding denials on the backside. 

Office/outpatient Practice

CPT Code	Description	Diagnosis
90384	Rho(D) immune globulin (RhIg), human, full-dose, for intramuscular use. (e.g. serum itself)	V07.2   Need for prophylactic immunotherapy V22.1   Supervision of other normal pregnancy 656.13 Rh Iso afft mgmt of mother antepartum
96372	Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular (e.g. injection of the serum)	V07.2   Need for prophylactic immunotherapy V22.1   Supervision of other normal pregnancy 656.13 Rh Iso afft mgmt of mother antepartum

Office/outpatient Practice

HCPCS/CPT Code	Description	Diagnosis
J2790	Rho D immune globulin, human, full dose, 300 mcg (1500 i.u (e.g. serum itself)	V07.2   Need for prophylactic immunotherapy V22.1   Supervision of other normal pregnancy 656.13 Rh Iso afft mgmt of mother antepartum
96372	Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular (e.g. injection of the serum)	V07.2   Need for prophylactic immunotherapy V22.1   Supervision of other normal pregnancy 656.13 Rh Iso afft mgmt of mother antepartum

 

Inpatient/Outpatient Facility

HCPCS/ICD-9 vol 3 procedure code	Description	Diagnosis
J2790	Rho D immune globulin, human, full dose, 300 mcg (1500 i.u (eg. serum itself)	V07.2   Need for prophylactic immunotherapy V22.1   Supervision of other normal pregnancy 656.13 Rh Iso afft mgmt of mother antepartum
99.11	Therapeutic, prophylactic, or diagnostic injection of Rh Immune Globulin	V07.2   Need for prophylactic immunotherapy 656.13 Rh Iso afft mgmt of mother antepartum This creates the issue where both methods of coding are correct.  The issue then falls upon the coder to determine how to code the service based upon how the 3rd party payer will reimburse for the service.