AbbeyMoor Medical Reimbursement FAQs
The reimbursement information provided is gathered from third-party sources and is intended to provide general information for reference purposes only. As such, AbbeyMoor makes no guarantee of coverage or payment. Reimbursement policies change frequently and can vary considerably from one insurer to another. AbbeyMoor strongly recommends that you consult your payers for interpretation of local coverage and reimbursement policies. Every reasonable effort has been made to ensure the accuracy of this information, however, the ultimate responsibility for coding and claims submission lies with the physician, clinician, hospital or other facility. Please refer to the 2007 CPT ® manual for specific guidance (CPT is a registered trademark of the American Medical Association).
How do I code for the insertion of The Spanner?
CPT code 0084T - Insertion of a temporary prostatic urethral stent
Can I charge for supplies used during the insertion of The Spanner?
No, the supplies are included in the procedure. The practice expense portion of the interim RVU includes the materials and equipment necessary to perform the procedure. CPT guidelines state materials customarily included in the surgical procedure should not be billed separately.
Can we bill for a separate evaluation and management service in addition to the insertion of the stent?
As noted in the CPT guidelines, the physician will need to indicate that on the day of the procedure the patient’s condition required a significant, separately identifiable E/M service above and beyond the services usually associated with the procedure that was performed. This circumstance may be reported by adding the modifier -25 to the appropriate level of E/M service.
How do I code for removal of The Spanner?
If the stent is removed by pulling on the tether you should code the appropriate Evaluation & Management level. There is no specific CPT code for the removal of a temporary prostatic urethral stent done in this manner. If a cystoscopy is required to remove The Spanner you may bill using the appropriate CPT code.
