This guide was developed to assist professionals and providers who are involved in using or obtaining reimbursement for the TULSA-PRO System. It addresses common coverage, coding, and payment issues. Correct claim submissions should may reduce requests for additional documentation from payers and mitigate claim denials or payment delays.
Profound Medical does not recommend the use of any specific diagnosis and/or procedure codes for a particular patient. The patient’s medical status and the medical record must support all diagnoses and procedures reported on a claim form. Only a physician is qualified to make the diagnosis and treatment decisions documented in the patient’s medical record.
The TULSA-PRO® procedure may be performed in sites of service that are paid under different payment systems by Medicare. The codes a provider uses to report the procedure may be different depending on whether the procedure is furnished in a hospital outpatient department or a facility that bills under the Medicare Physician Fee Schedule such as a Physician Office (OBL). In the document are the codes that may identify the procedure depending on the setting in which the service is provided and whether the claim is for the facility (hospital outpatient department) or physician service.