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    How to get reimbursed for BPH water vapor ablation

    Until introduction of new code in 2019, follow one of two coding pathways for payment

     

    At this point, we see two possible coding pathways:

    • Continue to report code 53852 (Transurethral destruction of prostate tissue; by radiofrequency thermotherapy).
    • Report Rezum with unlisted code 53899 (Unlisted procedure, urinary system insert “Rezum Transurethral destruction of prostate tissue; by radiofrequency thermotherapy” or “Rezum water vapor or steam thermotherapy for destruction of prostate tissue”) in box 19 of the claim form to assure prompt payment.

    You will need to consult your payer prior to providing this service to determine the correct approach for the payer and to make sure the service is covered. Consulting a payer should consist of reviewing current posted coverage policies and following instructions provided. If the coverage is unclear or there is no information posted, we recommend calling the payer for coverage and payment requirements.

    Read: How to bill for discontinued vasectomy procedure

    Other points to consider:

    • Payers may continue to request the use of code 53852 for ease of adjudication, or a payer may develop an edit on the unlisted code that allows processing of the service with the unlisted code without review of each claim.
    • Payers may also choose to require the unlisted code and require a review of each case submitted.
    • Payers may choose to consider Rezum as a non-covered service, allowing the practice to bill the patient directly for the service under the practice’s current fee schedule rate.
    • If the payer does not provide any instructions or information on current coverage and/or proper reporting of Rezum, it is left to the practice to choose to continue to report code 53852 unless the AUA or the American Medical Association publishes a coding recommendation indicating otherwise, or to use 53899 as noted above.

    Note: For payers that do not provide information on coverage or payment, remember that you will need to follow contractual instructions if contracted with the payer, which may or may not allow for collection of payment from the patient prior to claim adjudication, and likely will require appeal or submission of supporting materials for proper claim adjudication. For those payers with whom you are not contracted, collection from the patient is allowed; however, practice processes used for other services should be followed.

    More from Urology Times:

    What happens when prior auths don’t match services provided?

    How your practice can avoid medical necessity denials

    How to charge for E&M services, procedure on same date

     

    Send coding and reimbursement questions to Ray Painter, MD, and Mark Painter c/o Urology Times, at [email protected] Questions of general interest will be chosen for publication. The information in this column is designed to be authoritative, and every effort has been made to ensure its accuracy at the time it was written. However, readers are encouraged to check with their individual carrier or private payers for updates and to confirm that this information conforms to their specific rules.


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    Ray Painter, MD
    Urologist Ray Painter, MD, is president of Physician Reimbursement Systems, Inc., in Denver, and is also publisher of Urology Coding and ...
    Mark Painter
    Mark Painter is CEO of PRS Urology SC in Denver.

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