# **help** 99213, 51741, 5198



## bill2doc

please, please, please HELP!

pt comes in for an office visit for BPH 600.01 and Urge 788.31.  has a discussion with doc regarding symptions. Then doc wants to perform a Uroflow 51741 for the BPH and a PVR for Urge 788.31.  Carriers are appending the modifer -51 of the 51741 and 51798 and reducing the payment.  Is there no way I can append -59 ??  It seems to me that the office visit is seperate (history, eval, discussion) then decision to perform two separate procedures would warrant at -59 on each.....

Confussed and I hope that someone out there in the Uronogy world will save me.

Thanks!!!
Lynn


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## eileenfranklin1@gmail.com

*51798*

Hi Lynn;
We are having a similar problem. We are having denials when we bill the E/M and 51798 without a 25 modifier; as you know the 51798 has a XXX global therefore it should not need the 25. We have the CMS documentation to back this up but still have this problem with certain carriers.


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## bill2doc

Hmmm?  Do you put a 59 on the 51798?  I'm trying to know if I can append a -59 on 51741 and/or 51798 in order to avoid the reduction....???  I put a -25 on the OV or yes, its denying


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## mgmcminn@drmc.org

Are billing for both the professional and technical charges.  I am getting denials on 51798 professional charge.  They are paying tech but not prof.


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## eileenfranklin1@gmail.com

*51798 denials*

Since 1/1/13 we are getting medicare denials of 51798; is anyone else having this problem?


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## tmclaughlin

Yes.  They will pay for the facility fee but not the professional fee.  Have you had any other responses?


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## mitchellde

bill2doc said:


> please, please, please HELP!
> 
> pt comes in for an office visit for BPH 600.01 and Urge 788.31.  has a discussion with doc regarding symptions. Then doc wants to perform a Uroflow 51741 for the BPH and a PVR for Urge 788.31.  Carriers are appending the modifer -51 of the 51741 and 51798 and reducing the payment.  Is there no way I can append -59 ??  It seems to me that the office visit is seperate (history, eval, discussion) then decision to perform two separate procedures would warrant at -59 on each.....
> 
> Confussed and I hope that someone out there in the Uronogy world will save me.
> 
> Thanks!!!
> Lynn



the discount is normal and there is nothing you can do to make it not.    even the 59 will not stop it from discounting.  When you perform 2 or more procedures in the same session, then the second and subsequent will be reduced.  Some carriers still require the use of the 51 and some want it left off.


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## MikeEnos

Sorry, I'm way late to the party on this one - but I was just asked about a problem billing 51798 by a client.  Just like you, tmclaughlin, my client said they are only getting paid for the technical component.

The first thing I checked was my online coding resource, EncoderPro.  I pulled up 51798, and sure enough, there is a note which states:    
*"This code represents the technical component only with no associated physician involvement."  *

So why is the note there?  I have a theory.  After researching the August *2012 AMA/RUC Comments to CMS*, It appears that the RUC (Relative Value Scale Update Committee) assigned physician time to CPT code 51798 when it was implemented in 2003, and hence they assigned work RVU's to the code, since urologists typically perform the service.  However, CMS disagreed in the 2003 Medicare Final Rule and assigned only practice expense.  Just recently, CMS removed the physician time from the code at the RUC's recommendation - so it truly doesn't report physician services, even though it was originally intended to before CMS disagreed.  

That seems to indicate to me that there are no physician work RVU's included in this procedure.  Hence, it makes sense that any physician work can be reported with an E/M code.  You wouldn't think a modifier -25 would be needed, since the global concept doesn't apply to this code, but maybe some insurances require it anyway.

Here's some supporting info I found from the *Coding Corner of the American Urological Association's* website:



> Bladder Scan Confusion: If the physician’s intent is to obtain post-void residual urine, which code should my office be using?
> 
> Current Procedural Terminology (CPT®) code 51798 was established to capture the measurement of post voiding residual urine and/or bladder capacity by ultrasound, non-imaging. A hand-held doppler unit is used to perform this measurement of the bladder. The small transducer is passed across the abdomen. The transducer emits and detects high-pitched sounds beyond the range of human hearing. The sound waves are reflected back from the structures in the body and are converted into a picture. This type of unit will print out the volume and draw a graph of the bladder or provides some other printed report. This is not considered an “ultrasound image.” When performing a post-voiding residual (PVR) using a hand-held unit with a simple printout, use CPT® code 51798 for Medicare and commercial carriers.
> 
> In the Medicare reimbursement system, CPT® code 51798 has a XXX global indicator. This means that the global concept does not apply to this code. This same indicator applies to many radiological procedures. It can be performed at the same time as an evaluation and management service and should not be bundled. Some carriers are denying CPT® 51798 even though it is not subject to the bundling rules.


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