Local Coverage Article Billing and Coding

Billing and Coding: Fluid Jet System in the Treatment of Benign Prostatic Hyperplasia (BPH)

A57926

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Contractor Information

Article Information

General Information

Article ID
A57926
Article Title
Billing and Coding: Fluid Jet System in the Treatment of Benign Prostatic Hyperplasia (BPH)
Article Type
Billing and Coding
Original Effective Date
04/01/2020
Revision Effective Date
03/24/2022
Revision Ending Date
N/A
Retirement Date
N/A
AMA CPT / ADA CDT / AHA NUBC Copyright Statement

CPT codes, descriptions and other data only are copyright 2021 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.

Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.

Current Dental Terminology © 2021 American Dental Association. All rights reserved.

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CMS National Coverage Policy

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Article Guidance

Article Text

This Billing and Coding Article provides billing and coding guidance for Local Coverage Determination (LCD) L38378-Fluid Jet System in the Treatment of Benign Prostatic Hyperplasia (BPH). Please refer to the LCD for reasonable and necessary requirements.

Coding Guidance

Notice: It is not appropriate to bill Medicare for services that are not covered (as described by the entire LCD) as if they are covered. When billing for non-covered services, use the appropriate modifier.

Documentation Requirements

    1. All documentation must be maintained in the patient's medical record and made available to the contractor upon request.
    2. 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.
    3. 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.

 

Coding Information

CPT/HCPCS Codes

Group 1

(2 Codes)
Group 1 Paragraph

Note: Providers are reminded to refer to the long descriptors of the CPT codes in their CPT book.

Group 1 Codes
CodeDescription
C2596 PROBE, IMAGE-GUIDED, ROBOTIC, WATERJET ABLATION
0421T TRANSURETHRAL WATERJET ABLATION OF PROSTATE, INCLUDING CONTROL OF POST-OPERATIVE BLEEDING, INCLUDING ULTRASOUND GUIDANCE, COMPLETE (VASECTOMY, MEATOTOMY, CYSTOURETHROSCOPY, URETHRAL CALIBRATION AND/OR DILATION, AND INTERNAL URETHROTOMY ARE INCLUDED WHEN PERFORMED)

CPT/HCPCS Modifiers

N/A

ICD-10-CM Codes that Support Medical Necessity

Group 1

(1 Code)
Group 1 Paragraph

It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim(s) submitted.

The following ICD-10-CM codes support medical necessity and provide coverage for (CPT/HCPCS) codes: 0421T and C2596

Group 1 Codes
CodeDescription
N40.1 Benign prostatic hyperplasia with lower urinary tract symptoms

ICD-10-CM Codes that DO NOT Support Medical Necessity

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ICD-10-PCS Codes

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Additional ICD-10 Information

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Bill Type Codes

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the article should be assumed to apply equally to all claims.

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Revenue Codes

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the article should be assumed to apply equally to all Revenue Codes.

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Other Coding Information

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Revision History Information

Revision History DateRevision History NumberRevision History Explanation
03/24/2022 R5

R5
Revision Effective: 03/24/2022
Revision Explanation: Annual review, no changes were made.

03/25/2021 R4

R4
Revision Effective: 03/25/2021
Revision Explanation: Annual review, no changes were made.

11/09/2020 R3

R3
Revision Effective: 11/09/2020
Revision Explanation: Updated notice period for policy until 11/08/2020. This is the final notice period as all comments have been reviewed. The billing and coding article new effective date is 11/09/2020 to be in align with its related policy.

11/01/2020 R2

R2
Revision Effective: 11/01/2020
Revision Explanation: Policy has had notice period extended and will not become effective until 11/01/2020. The billing and coding article new effective date is 11/01/2020 to be in align with its related policy.

04/01/2020 R1

R1

Revision Effective: 04/01/2020

Revision Explanation: This is a non-covered procedure based on the related policy. The ICD-10 code listed in group one ICD-10 was listed in error and has been removed.

Associated Documents

Related Local Coverage Documents
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Related National Coverage Documents
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Statutory Requirements URLs
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Rules and Regulations URLs
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CMS Manual Explanations URLs
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Other URLs
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Public Versions
Updated On Effective Dates Status
03/18/2022 03/24/2022 - N/A Currently in Effect You are here
03/19/2021 03/25/2021 - 03/23/2022 Superseded View
Some older versions have been archived. Please visit the MCD Archive Site to retrieve them.

Keywords

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