The urologist and the urogyenecologist often use bladder diary in helping them diagnose and properly treat patients that may have the overactive bladder or urinary incontinence. Go through this medical billing and coding training article to know more.
Now, when they review the diary that has been filled out by the patient, they often look at the timing of the incontinence when it happens in the morning or in the evening. The context is the urgency or stress incontinence. How severe is it? How many pads does the patient require during the day?
And also, they may look at and find in the diary associated signs and symptoms such as burning of urination, back pain, or maybe episodes of hematuria. Now, when they review these prompts, these items and they review four of these items, they are actually fulfilling the requirements for a level four of the history of the present illness, the HPI whether it's a new, a 99204 or an established office visit, a 99214. And where we're still using consultation codes, it may qualify for history of the present illness for a 99244.
ICD and CPT updates in female urology and urogynecology
Let us focus on two ICD diagnostic medical coding options -- 618.81 which is incompetence or weakening of pubocervical fascia and code 618.82, incompetence or the weakening of a rectovaginal fascia. Now, these codes or these ICD diagnoses will give the medical necessity for a anterior and posterior placement of a mesh.
Also note the 618.00 unspecified prolapse of vaginal walls, 618.09, the prolapse of vaginal walls without the uterine prolapsed, and 618.5 prolapsed of vaginal wall after a hysterectomy.
The only new code, new CPT code introduced in 2010 that applies to female urology and urogynecology is the new code 57426. This is the revision including removal of a prostatic vaginal graft. And we do this via a laparoscopic approach.
You would do this when you have performed an abdominal sacrocolpopexy. And you must go back laparoscopically to remove the mesh because of infection or pain that the patient may experience from this mesh being in place.
Medical Coding and Billing for Removal and Replacement
When you're coding for the removal and placement of a particular entity or particular device, most often, the coding policy is not to bill for the removal of a particular device but just for the replacement. Just like when we remove and we replace a J-stent.
In the past, we were able to bill for the removal, 52310 and the placement, the 52332. That has been changed many years ago. And for the removal and the replacement, we only bill or we're only paid on the replacement of the stent, like the 52332.
This holds for many of these devices and implants that are placed. So here, we have the codes 64590. It's the insertion or replacement of a peripheral neurostimulator pulse generator. And this includes removal of the generator. So if you take it out and you put it in, it's 64590.
Now, if you just take out an electrode and do not replace it, you may want to bill a code 64585 with modifier -78 because you're in the global period. And this is just the removal.
Now the implantation of an electrode wire, 64581, the incisional implant, not in the global period, it would be using the 64581 for removal and replacement. This code would also include removal of the electrode or wire.
At times, urologists will implant these electrode wires both percutaneously on one side and via an incision on the other side. Let's look at the medical coding for this. The procedure was a left percutaneous insertion of an electrode, and also a right incisional insertion of electrode under fluoroscopic control.
Now for Medicare, we bill just for the placement, 64581, for the right side incisional. And we also want to bill for the left percutaneous insertion of the electrode. That code, the 64561, is bundled into the 64581. And then we also bill in the hospital for the use of fluoroscopy.
Now, with non-Medicare carriers, you can bill where we don't really know the bundling edits. We can bill the 64581 on the right side, the incisional insertion, and 64561 on the left side with modifier -51 also.
Coding and Compliance Tip: Notice that when you bill with modifiers, the numbered modifier always goes before the lettered modifier. Now, once we have done these incisional and percutaneous insertions, now we're going to insert a permanent generator. That's usually two to three weeks after the incisional insertion. And we use the code 64590 with modifier -58.
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