Part B Insider (Multispecialty) Coding Alert

You can bill a distinct E/M visit separately

Do you know the score about bladder scan code 51798? Here are three common misconceptions that could be costing you money.

Myth #1: You should bill an ultrasound code if the doctor used an ultrasound device to perform the bladder scan.

Reality: If the purpose of the scan was to measure post-voiding residual urine, you should always bill 51798. Generally, you-ll use this code when the urologist positions a portable ultrasound scanner over the suprapubic area to measure the residual urine. Most of these scanners actually print out a tape, which should remain part of the permanent medical record, says Margaret Atkinson, business manager with Centennial Surgery Center in Voorhees, NJ.

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

The portable scanner's built-in software will record the post-void residual urine volume and -provide the bladder's capacity based on the patient's actual bladder shape,- says Atkinson. If this scan shows a large amount of residual urine, indicating retention, then the urologist will catheterize the patient. If this happens, you can bill the catheterization separately, say experts.

Myth #2: You can't bill an evaluation & management visit with 51798.

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

But you-ll probably need a 25 modifier, Atkinson adds. 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, you shouldn't bill for it.

Myth #3: A doctor can bill separately for interpretation if someone else performs 51798 offsite.

Reality: Because 51798 has no separate professional or technical component, you can't bill only for professional services, says Richmond. There's no interpretation involved, because 51798 is only a measurement. You can bill for interpretation if the doctor interprets a larger pelvic (76856), bladder (75657) or bladder and kidney ultrasound (76770).