Question: We have always reported A4556 for the electrodes our urologist uses during urodynamics procedures. This year, however, DMERC has refused reimbursement, stating we should instead be using code A4595 or A4557. Those two “replacement” codes are the completely wrong description of the EMG patch (A4556). How should I code?
Answer: According to recent Local Coverage Determinations (LCDs) for Medicare and set policy for many states, “equipment, fluids, gases, probes, catheters, medications, tubings, gloves, sterile supplies … [ should be] … supplied … and not billed separately.” That means you need to include the cost of these supplies in the fee for each urodynamic code performed.
Exception: If your carrier does reimburse for some supplies (as your carrier paid for the probes), bill using the codes suggested by the carrier even if they may appear inappropriate at the time. You may speak with your carrier’s representative about your concerns of possible incorrect coding, but in general, follow the carrier’s guidelines and ask for a written statement outlining their policy. It will always help to have written documentation if the carrier questions your billing practices in the future.
For more urology advice, turn to Urology Coding Alert written by Leesa A. Israel, BA, CPC, CUC, CMBS.