10 Highest Billed Urology Procedure Unexpected Denial Rates

Here are the top 10 highest billed urology procedures (CPT and HCPCS) with related unexpected denial rate, sorted by unexpected denial rate in the last 90 days, according to a report from RemitDATA.

 The unexpected denial rate removes expected denials that are typically a part of a "bill for denial" claim (on the claim the item isn't covered by the carrier, but you must receive a denial stating this so you can bill the secondary carrier).  Users have the option to remove expected denials from their view so they can obtain a "truer' denial rate, the unexpected denial rate.

1.       Q2043: Sipuleucel-T, minimum of 50 million autologous, CD54+ cells activated with PAP-GM-CSF, including leukapheresis and all other preparatory procedures, per infusion – 16 percent

2.       52332: Cystourethroscopy, with insertion of indwelling ureteral stent (EG, Gibbons or Double-J Type) – 15 percent

3.       55866: Laparoscopy, surgical prostatectomy, retropubic radical, including nerve sparing; includes robotic assistance, when performed – 12 percent

4.       99204: Office or other outpatient visit for the evaluation and management of a new patient which requires these three key components: a comprehensive history; a comprehensive examination; medical decision making of moderate complexity. Counseling and/or coordination – 10 percent

5.       50590: Lithotripsy, extracorporeal shock wave – 10 percent

6.       51798: Measurement of post-voiding residual urine and/or bladder capacity by ultrasound, non-imaging – 9 percent

7.       J9217: Leuprolide Acetate (for deposit suspension), 7.5 MG – 9 percent

8.       52000: Cystourethroscopy (separate procedure) – 9 percent

9.       99213: Office or other ambulatory care visits for the assessment and management of a patient established, which requires at least two of these three key components: An extended problem-based history; an extended problem-based review; medical decision-making of low complexity usually or right before the presentation problems are of the mild to moderate severity – 7 percent

10.   99214: Office or other outpatient visit for the evaluation and management of an established patient, which requires at least two of these three key components: A detailed history; a detailed examination; medical decision making of moderate complexity – 7 percent

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