Ob-Gyn Coding Alert

Uncover how you can bill a distinct E/M visit separate from 51798.

If you don't know the nuances of bladder scan coding and the opportunity to report an E/M code, you could be missing out on $63 your ob-gyn legitimately deserves. Here are three common misconceptions that could be costing you money.

You could land yourself in hot water if you believe you should bill a particular ultrasonic CPT code if your ob-gyn used an ultrasonic device to perform the bladder scan.

Reality: If the scan's sole purpose was to measure post-voiding residual urine, you should always bill 51798 (Measurement of post-voiding residual urine and/or bladder capacity by ultrasound, non-imaging). Generally, you-ll use this code when the ob-gyn positions any ultrasonic scanner over the suprapubic area to measure the residual urine, says Candy Cates, CPC, billing coordinator for Eastside GYN in Fort Smith, Ark. This scan "is an alternative, noninvasive method to avoid potential complications of increased urinary infection risk, urethral trauma, and discomfort for the patient."

Most of these scanners actually print out an image or a tape, which should remain part of the permanent medical record, says Margaret Atkinson, business manager with Centennial Surgery Center in Voorhees, N.J.

This image or tape will be your proof of the service the ob-gyn performed and will also justify the necessity for catheterization, if performed. If the scanner doesn't print out a tape or image (which is unusual), the physician must document what he did and the test's actual results.

Example: Your ob-gyn performs a bladder scan ultrasonically to determine the postvoid residual urine (PVR) and finds that the bladder did not empty completely. He then inserts an indwelling Foley catheter to drain the remaining urine. Be sure the ob-gyn either includes the report from the machine or documents the test and results in detail. You should report 51798.

Note: Your ob-gyn would not need to catheterize the patient because the scan tells you how much urine is left in the bladder. Therefore, you should not report 51701 (Insertion of non-indwelling bladder catheter [e.g., straight catheterization for residual urine]).

Thinking you can never bill an E/M visit when you report 51798 means that you could be costing your practice money it rightfully deserves. For instance, if you miss out on reporting 99213 (Office or other outpatient visit -), you-ll cost your practice $63.31 in 2009.

Reality: You can bill a separate E/M visit, says Donna Richmond with CodeRyte in Bethesda, Md.

Caution: For many carriers, including some Medicare carriers, you may need to append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to the E/M code, Cates says.

The carriers are scrutinizing separate E/Ms with 51798 very closely, so if you don't have a separate diagnostic reason for an E/M visit, they may deny you payment. CPT and Medicare rules will allow the same diagnosis for the E/M service with modifier 25 and the procedure on the same day and will reimburse for both with the same diagnosis, but the documentation should clearly establish that the visit's purpose was not to perform the bladder scan.

If someone else performs the bladder scan off-site, you can code separately for the study's interpretation.

Reality: Because 51798 has no separate professional or technical component, you can't bill only for professional services, Richmond says. There's no interpretation involved, because 51798 is only a measurement.

How it works: Medicare's fee schedule does not split 51798 into professional and technical components, so you can't split the reimbursement by appending modifiers 26 (Professional component) and TC (Technical component).

If your ob-gyn reads the results after a separate facility performs the actual measurement, you should include the study's professional interpretation in your E/M service's medical decision making. Bill only for your E/M services for the day, which would include the ob-gyn reviewing the result.

Alternative: If the ob-gyn does a full pelvic sonogram (76856), an anatomical bladder sonogram (76857), or a renal sonogram (76775) -- which all have both technical and professional components -- off-site, you may report the interpretation. Use modifier 26 appended to any of the previously mentioned performed codes provided the ob-gyn alone and not the radiologist does the study's interpretation.