Coding Corner: How to Report Home Uroflow

By Policy and Advocacy Brief posted 07-08-2020 17:12


Q: We were approached by a company offering a home uroflow device for patients, and telling us that if the patient sends us the results then we can charge for the uroflow and also for remote patient monitoring. Is this true?

This is an excellent question. Recently there have been a number of companies that have ways of measuring a uroflow from the patient’s home, either using a home device or a smartphone app. We do believe we will be seeing more of these types of devices in the future, especially as we proceed further into telemedicine. When looking into what codes a provider may use to bill these services, on the surface some codes may seem to fit. However, when taking a deeper dive into which codes are appropriate, there are a few limited options. Let’s look at possible codes:

CPT 51741 Complex uroflowmetry (e.g., calibrated electronic equipment)

CPT code 51741 contains both a “professional” component (for interpreting the data) and a “technical” component (for owning and maintaining the equipment). Since the provider’s office is not providing the equipment and upkeep, the office cannot bill for the technical portion of the procedure; and therefore, cannot bill the procedure “globally” (both the technical and professional component). The interpretation of a home uroflow test can be reported using CPT code 51741 appended with Modifier 26 (Professional Component) using place of service 12 (home). This should not be billed more than once per day, and the medical necessity for home uroflow should be 1 to 2 times per patient and document a change in plan. If the provider uses this code, then the data cannot be applied to the “data” section of medical decision making on a subsequent evaluation and management visit, as the interpretation has already been reimbursed and one cannot re-bill services separately reportable.  

CPT code 99457 Remote physiologic monitoring treatment management services, 20 minutes or more of clinical staff/physician/other qualified health care professional time in a calendar month requiring interactive communication with the patient/caregiver during the month; first 20 minutes

Remote physiologic monitoring codes were created for use for continuous cardiac monitoring (24 hours a day, wearable device) and were valued for that use. To use these codes, the patient is supplied with an FDA-approved continuous monitoring device that is typically provided by the practice and loaned out to the patient (hence CPT codes 99453 Remote monitoring of physiologic parameter(s) (e.g., weight, blood pressure, pulse oximetry, respiratory flow rate), initial; set-up and patient education on use of equipment and 99454 Remote monitoring of physiologic parameter(s) (eg, weight, blood pressure, pulse oximetry, respiratory flow rate), initial; device(s) supply with daily recording(s) or programmed alert(s) transmission, each 30 days, which provide practice expense valuation but have no physician work).

Intermittent use to monitor uroflow does not meet the definition of a continuous monitoring device. In addition, it is unclear if the urine flow rate is even considered a physiologic parameter. If one were to bill this code, the monitoring must be continuous, and for at least 16 days, and the clinician must spend > 20 minutes of time calendar month for work/interpretation, and an assessment of the patient’s clinical stability and communication of the results to the patient.

99091 Collection and interpretation of physiologic data (e.g., ECG, blood pressure, glucose monitoring) digitally stored and/or transmitted by the patient and/or caregiver to the physician or other qualified health care professional, qualified by education, training, licensure/regulation (when applicable) requiring a minimum of 30 minutes of time, each 30 days

CPT code 99091 is the closest option for billing these services. To bill this code, a physician or other qualified health care professional collects and interprets physiologic data, which is stored digitally and may be transmitted by the patient and/or the caregiver to the provider. The report should contain the time it took the provider to acquire the physiologic data, review and interpret the data, and modify any care plan due to the additional data acquisition. To use this code, the provider would need to document that they spent > 30 minutes of time interpreting the uroflows and to discuss the results with the patient. If this code is used, one could not bill for the individual uroflow study itself, because the same service cannot be billed twice and services separately reportable cannot be billed. It is unclear also if urine flow parameters meet the definition of physiologic data.   

Conclusion: So how can we bill for the interpretation of home uroflow data that is sent to us? It seems reasonable to bill CPT 51741 with modifier 26 one or two times. Insurers may deny reporting of a single CPT code multiple times in one day. Alternatively, if you are viewing a series of uroflows that takes > 30 minutes of clinician time, including discussing the results with the patient, then consider using CPT code 99091. The clinician (practice) cannot bill for both the uroflow interpretation (51741-26) and collection and interpretation (99091) on the same patient same day. Alternatively, one can have the patient bring in the results of their uroflow tests and use it as part of the “data” section for medical decision making for a follow-up evaluation/management visit.  

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