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Fun with Medicare & CPT® code 51840 - Gender specific??
Hoping somebody has dealt with this or a similar issue before.
Medicare (NORIDIAN) is denying CPT® code 51840 (anterior vesicourethropexy) performed on a male stating this code is gender specific to females only.
Our CPT® book actually states: this code is generally performed on females. However, nothing in this code denotes gender.
Noridian is denying it and they state their CPT® code book states "this CPT® code applies strictly to females".
Our practice has been billing Medicare for this code for years. We never had a problem when our contractor was Palmetto but now that it's Noridian we are having all kinds of issues of this type.
Does anyone have a CPT® denifition of this code that states it is strictly a female code?
Thanks in advance.
re: Fun with Medicare & CPT® code 51840 - Gender specific??
Yes, that is female specific.
re: Fun with Medicare & CPT® code 51840 - Gender specific??
Can you please give me a CPT® book you concluded that this code is gender specific from? Because, as I said, our CPT® book says, in black and white, this code is not gender specific.
re: Fun with Medicare & CPT® code 51840 - Gender specific??
I'm with you - this code isn't gender specific according to the AMA. It's used to treat urinary stress incontinence, which predominantly females suffer from, but males can also have urinary stress incontinence. I would contact the AUA to see if they can offer any insight or have additional material you can submit with your appeal.
re: Fun with Medicare & CPT® code 51840 - Gender specific??
Thank you! I will do that.
re: Fun with Medicare & CPT® code 51840 - Gender specific??
Just wanted to update this - I appealed Medicare's denial of this CPT® code and my appeal was successful. I had this issue on 7 male patients. Noridian is a pain....