Urodynamics is a study that assesses how the bladder and urethra are performing their job of storing and releasing urine. Urodynamic tests help your doctor see how well your bladder and sphincter muscles work and can help explain symptoms such as:
sudden, strong urge to urinate
problems starting a urine stream
urinary tract infection (recurrent)
Urodynamic tests are usually performed in UROLOGY, GYNECOLOGY, OB/GYN, INTERNAL MEDICINE, and PRIMARY CARE offices. Urodynamics will provide the physician with the information necessary to diagnose the cause and nature of a patient's incontinence, thus giving the best treatment options available. Urodynamics is typically conducted by urologist, urogynecologist, or specialist urology nurse.
The tests are most often arranged for men with enlarged prostate glands, and for women with incontinence that has either failed conservative treatment or requires surgery.
Symptoms reported by the patient are often an unreliable guide to the underlying dysfunction of the lower urinary tract. The purpose of urodynamics is to provide objective confirmation of the pathology that a patient's symptoms would suggest.
For example, a patient complaining of urinary urgency (or rushing to the toilet), with increased frequency of urination can be said on the basis of their symptoms to have overactive bladder syndrome. The cause of this might be detrusor overactivity, in which the bladder muscle (the detrusor) contracts unexpectedly during bladder filling. Urodynamics can be used to confirm the presence of detrusor overactivity, which may help guide treatment. An overactive detrusor can be associated with urge incontinence.
These tests involving imaging equipment that films urination and pressure monitors that record the pressures of the bladder and urethra.
A typical urodynamic test takes about 45 minutes to perform. It involves the use of a small catheter used to fill the bladder and record measurements. What is done depends on what the presenting problem is, but some of the common tests conducted are:
- Uroflowmetry: free uroflowmetry measures how fast the patient can empty his/her bladder. Pressure uroflowmetry again measures the rate of voiding, but with simultaneous assessment of bladder and rectal pressures. It helps demonstrate the reasons for difficulty in voiding, for example bladder muscle weakness or obstruction of the bladder outflow.
- (PVR) Post-void residual volume: Most tests begin with the insertion of a urinary catheter/transducer following complete bladder emptying by the patient. The urine volume is measured (this shows how efficiently the bladder empties). High volumes (180 ml) may be associated with UTI. A volume of greater than 50 ml in has been described as constituting post-void residual urine. High levels can be associated with overflow incontinence.
- (CMG) Multichannel cystometry: measures the pressure in the rectum and in the bladder, using two pressure catheters, to deduce the presence of contractions of the bladder wall, during bladder filling, or during other provocative manouevres. The strength of the urethra can also be tested during this phase, using a cough or Valsalva manouvre, to confirm genuine stress incontinence.
- (UPP) Urethral pressure profilometry: measures strength of sphincter contraction.
- (EMG)Electromiography measurement of electrical activity in the bladder neck .
|Procedure/Test Performed||2009 CPT Codes||2012 CPT Codes|
|Complex CMG only||51726||51726|
|Complex CMG with UPP/VLPP studies||51726 and 51772||51727 (all inclusive)|
|Complex CMG with voiding pressure profile||51726 and 51795||51728 (all inclusive)|
|Complex CMG with voiding pressure profile and UPP||51726, 51772 and 51795||51729 (all inclusive)|
|Voiding pressure profile, intrabdominal||51797||51797 (bill w 51728 OR 51729)|
|Simple uroflow||51736||51736 (add if performed)|
|Complex uroflow||51741||51741 (add if performed)|
|Electromyography (EMG) of anal or urethral sphincter, other than needle||51784||51784 (add if performed)|
|Bladder Volume Scan (PVR)||51798 ||51798|
Medicare reimbursement will range from $750-$900 per patient.
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