Basics of Simple and Complex Cystometrogram CPT codes

Cystometry, or cystometrogram, with a pressure flow study is part of urodynamic testing (or UDS). These tests measure how well the bladder functions. Simple cystometrogram (CMG) is an appropriate diagnostic test when there is no access to complex CMG during urodynamic testing. It is emerging as a reliable indicator to determine a diagnosis of overactive bladder, urinary incontinence, and interstitial cystitis. The catheter is connected to a manometer, an instrument used to measure the pressure of fluid. Fluid is then infused through the catheter into the bladder. Bladder sensations and bladder volume are recorded at predefined physiologic landmarks. Each rise in vesical pressure is accounted for by careful observations. CPT code 51725, 51726, 51727, 51728 and 51729 used to report simple and complex cytometrography.

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Description of cystometrogram CPT code 51725, 51726, 51727, 51728 & 51729

51725 Simple cystometrogram (CMG) (eg, spinal manometer)
51726 Complex cystometrogram (ie, calibrated electronic equipment);
51727 with urethral pressure profile studies (ie, urethral closure pressure profile), any technique
51728 with voiding pressure studies (ie, bladder voiding pressure), any technique
51729 with voiding pressure studies (ie, bladder voiding pressure) and urethral pressure profile studies (ie, urethral closure pressure profile), any technique

For a simple cystometrogram (CPT code 51725), the physician inserts a pressure catheter into  the bladder and connects it to a manometer line filled with fluid to measure pressure and flow in the lower urinary tract. For a complex cystometrogram (CPT code 51726), the physician typically uses a transurethral catheter to fill the bladder with water or gas while simultaneously obtaining rectal pressure. As the bladder is being filled, intravesical pressure is measured by a microtip transducer or fluid-filled catheter attached to the transducer. CPT code 51727 reports a complex cystometrogram performed in conjunction with a study for measuring urethral pressure. In one technique, the bladder is filled with fluid and the catheter withdrawn into the urethra while bladder sensations and volume are recorded. Urethral pressure changes are recorded as the patient follows specific instructions (Valsalva maneuver, cough). For voiding pressure studies performed in conjunction with a complex cystometrogram (CPT code 51728), a transducer is placed into the bladder and the bladder is filled with fluid. The patient is instructed to attempt to void upon the feeling of bladder fullness, and recordings are taken of bladder sensation and volume at specific times. Always report CPT code 51729 if complex cystometrogram is combined with both voiding pressure studies and urethral pressure profile studies.

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Sample coded report for Complex cystometrogram CPT code

Indication for Surgery: Incontinence
Preoperative Diagnosis: Same
Postoperative Diagnosis:Incontinence & dysfunctional voiding
Operation:Videourodynamics

Anesthesia: Local
Estimated Blood Loss:None
Urine Output

Findings: No incontinence demonstrated. Dysfunctional voiding.
Specimen(s)

Complications: None
Technique: Uroflowmetry was performed. Videourodynamics were performed in the sitting position with leak point pressures also measured in the standing position. A catheter was placed in the bladder for measurement of intravesical pressures and one in the rectum for measurement of abdominal pressures. EMG electrodes were placed in the perirectal area. Please see the formal report located on the chart for details. Briefly, she had a stable bladder with normal compliance and no uninhibited contractions. No incontinence demonstrated with provocative maneuvers. She exhibited dysfunctional voiding with an intermittent flow pattern.

Details of study:
Filling study: 1st sensation, 1st desire, strong desire, and capacity were reached at 20 cc, 240 cc, 365 cc, 397 cc.
Voiding study: Max flow 21.7, average 8.4, volume 434, pressure at peak flow 18.3, postvoid residual 0
EMG: Sphincter activation with attempts to void

CPT code : 51728