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10 Highest Billed Urology Procedure Unexpected Denial Rates

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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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