Article - Billing and Coding: Urodynamic Services - Non-invasive (A58543)

CMS National Coverage PolicyInternet-Only Manuals (IOMs)CMS IOM Publication 100-03,Medicare National Coverage Determinations (NCD) Manual,Chapter 1, Section 230.2 Uroflowmetric EvaluationsCMS IOM Publication 100-02,Medicare Benefit Policy Manual,Chapter 15, Section 60 Services and Supplies, Section 80 Requirements for Diagnostic X-Ray, Diagnostic Laboratory, and Other Diagnostic TestsCMS Publication 100-08,Medicare Program Integrity Manual,Chapter 13, Section 13.5.4 Reasonable and Necessary Provision in an LCDFederal Register References:42 Code of Federal Regulations, 410.32 Diagnostic x-ray tests, diagnostic laboratory tests, and other diagnostic tests: Conditions42 Code of Federal Regulations, 410.33 Independent diagnostic testing facility42 Code of Federal Regulations, 410.74 Physician assistants services42 Code of Federal Regulations, 410.75 Nurse practitioners services42 Code of Federal Regulations, 410.76 Clinical nurse specialists servicesSocial Security Act (Title XVIII) Standard References:Title XVIII of the Social Security Act, Section 1833(e) states that no payment shall be made to any provider of services or other person under this part unless there has been furnished such information as may be necessary in order to determine the amounts due such provider or other person under this part for the period with respect to which the amounts are being paid or for any prior period.Title XVIII of the Social Security Act, Section 1862(a)(1)(A) excludes expenses incurred for items or services which are not reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member.Article TextUrodynamic tests include: Cystometry, Electromyography, Urethral Pressure Profile, Uroflowmetry and Voiding Pressure Study; which are used to define the functional status of the lower urinary tract and to assist in the diagnosis of signs and symptoms of lower urinary tract problems or to guide further medical and/or surgical decision-making for urologic dysfunction.The penile cuff is a non-invasive diagnostic test for male urinary disorders, also known as lower urinary tract symptoms (LUTS) such as urgency, frequency, nocturia and incomplete emptying. The test uses an external penile cuff (resembling a blood pressure cuff) instead of a catheter to measure bladder pressure while also calculating urine flow rate. This Billing and Coding Article provides billing and coding guidance for Urodynamic testing performed when using a penile pressure cuff for a urethral pressure study.Coding GuidanceNotice:It is not appropriate to bill Medicare for services that are not covered (as described by the entire Billing and Coding Article) as if they are covered. When billing for non-covered services, use the appropriate modifier.When there is no CPT/HCPCS code available to describe the service(s) performed, the appropriate CPT/HCPCS Not Otherwise Classified (NOC) code must be submitted.Non-invasive urodynamic studies, i.e., those performed without catheterization are to be reported using the CPT code 55899 with non-invasive urodynamic studies (e.g. UroCuff) noted in the narrative portion of the claim.Documentation RequirementsAll documentation must be maintained in the patient's medical record and made available to the contractor upon request.Every page of the record must be legible and include appropriate patient identification information (e.g., complete name, dates of service[s]). The documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care to the patient.The submitted medical record must support the use of the selected ICD-10-CM code(s). The submitted CPT/HCPCS code must describe the service performed.Documentation includes signs and symptoms of voiding dysfunction, a relevant medical history, physical exam, urinalysis with urine microscopy and effectiveness of treatment when there is a diagnosis of urinary tract infection.Printouts from the electronic equipment are considered part of the documentation and should be included in the patients official medical record in addition to the professional interpretation and supervision report.