Coding for UroVysion

This article clarifies appropriate billing of UroVysion” and it replaces all previous articles on this subject.

UroVysion is an FDA-approved, proprietary, bladder cancer kit using fluorescent in-situ hybridization (FISH) testing with multiple probes performed simultaneously. It is marketed by Abbott Laboratories and used as an aid in patients with hematuria for the initial diagnosis of bladder cancer and also for subsequent monitoring for tumor recurrence in patients previously diagnosed with bladder carcinoma. The test kit is not approved for, and should not be billed to, Medicare for any other purpose.

Since this test uses multiple probes which are applied and then reviewed simultaneously, it is not correctly or completely identified by any of the following codes used either alone or in any combination:

• 88365 In-situ hybridization (eg, FISH), each probe
• 88367 – Morphometric analysis, in-situ hybridization, (quantitative or semi-quantitative) each probe; using computer-assisted technology
• 88368 – Morphometric analysis, in-situ hybridization, (quantitative or semi-quantitative) each probe; manual

Instead, this testing should be billed to Medicare using the single code:

• 88399 Unlisted surgical pathology procedure:

The word UroVysion should be placed in the comment field, and billed as a single unit of service (UOS = 1) for the complete test.

Medicare will pay for the procedure at an amount designed to fairly compensate for the work, practice expense and practice liability of the simultaneously reviewed multiple probes. Given the clinical uses of the test (often as an alternative to Q3-6 month surveillance cystoscopy), it is not appropriate to use this test more often than once in a three-month interval.

Applies to the states of: AK, AZ, HI, MT, ND, NV, OR, SD, UT, WA & WY. Effective Immediately

Source: https://www.noridianmedicare.com