April 08, 2022

UCR 091: FAQs - Remote uroflow; Interstim covered diagnoses issue; TURP and bladder scan during global; Robot-assisted laparoscopic prostatectomy

26 minutes

Available April 8, 2022

Mark, Scott, and Ray answer questions

1) My clinic is trying out the app through Emano Flow that tracks a patients urine flow for 14 days and then the Urologist goes over the results with the patient when the trial is finished. My clinic is very confused on whether or not each individual day needs an interpretation written by the doctor in order to bill a uroflow (51741) on a particular day?

2) [9:05] I am working on an appeal letter to Regence Blue Shield for in Interstim device. In their criteria for coverage, the covered diagnoses for this type of treatment are: a. Urge Incontinence (N39.41), b. Non-obstructive urinary retention (R33.8), c. Overactive bladder (N32.81) and d. Urgency-Frequency syndrome (??). For D, I could use the symptom codes of R39.15 and R35.0.........but is there anything else that might be better? The documentation states the female patient has Fowler's Syndrome, but there isn't an ICD-10 for that either! Suggestions???

3) If a Medicare has a TURP 52601 and then two months later has a bladder scan in the office 51700 should Medicare pay for that bladder scan?

4) What is the difference betweent simple prostatectomy codes 55821 and 55831. What is the best way to code for Robot-assisted laparoscopic simple prostatectomy on a Medicare patient? And, same question for a commercially insured patient?

UTI – PCR UPDATE

The following Medicare Administrative Contractors (MAC) aka Carriers, have issued a proposed multi-jurisdictional Local Coverage Decision (LCD) for Multiplex Nucleic Acid Amplification Test (NAAT) PANELS FOR INFECTIOUS DISEASE Testing, Wisconsin Physician Services Insurance Corporation, CGS Administrators, LLC., Noridian Healthcare Services, LLC., and Palmetto GBA.

Each has also issued an associated Local Coverage Article (LCA) with coding instructions and limitations on coverage. Each of these states participate in the MolDX program administered by Palmetto GBA. The coverage change takes effect April 17, 2022 in all states within each jurisdiction...

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