Coding & Reimbursement Resources
The AUGS Coding and Reimbursement Committee assists members with the application of governmental regulations and guidelines regarding terminology and CPT/ICD coding in urogynecologic practice. Such information is intended to assist with the coding process as required by governmental regulation and should not be construed as policy sanctioned by AUGS. The following resources are available:
Coding Q&A for AUGS Members (log in to AUGS website required to access feature)
Physican Reimbursement Resources
AUGS member alert: New United HealthCare policies require additional preauthorization for certain procedures based on site of service
AUGS is notifying its Members of increased payer requirements from United Healthcare regarding the location of service for certain surgical procedures, in part due to variability in reimbursement based on the site of service. Many hospital systems provide a variety of surgical locations and facility charges can vary depending on venue in a hospital or an ambulatory surgical center setting. Click here for an educational fact sheet regarding these changes and what you can do to help.
This is reportedly the result of a claims processing system error which has resulted in a CPT –ICD9 mismatch. This appears to be affecting claims from May 2015 to the present. Claims for the sacral lead placement are not currently affected.
Novitas is aware of the system error. Physicians are advised to contact Novitas Customer Care to report the denial and ask that the claim be escalated.
CMS Conversion Factor
Change Request (CR) 9104 informs MACs about the release of pyament files based upon the CY 2015 Medicare Physician Fee Schedule (MPFS) Final Rule. To be sure that you and your billing staff are of these changes, please click here for the New CMS Conversion Factor
FPMRS Taxonomy Code
Coding for Robotic Surgery
Coding for Urodynamic Procedures
Posterior Tibial Nerve Stimulation (PTNS) Therapy