Urology Coding Alert

Confidently Code Bladder Scan Diagnoses

Published on Tue Apr 01, 2003

One fundamental concept should drive your bladder scan ICD-9 Coding: Bladder scans are diagnostic tests.

When there isn't a national policy issued by the Centers for Medicare & Medicaid Services (CMS) outlining the covered diagnosis codes for a procedure and you must constantly figure out which diagnosis codes will be acceptable for a given procedure, it is a good idea to stick with what you already know. Use the standard requirements for coding diagnostic tests issued by CMS in September 2001 to guide your diagnosis coding for the new bladder scan code 51798 (Measurement of post-voiding residual urine and/or bladder capacity by ultrasound, non-imaging).

Grasp the Diagnostic Test Dx Basics

How you assign diagnosis codes for diagnostic tests really depends on whether you submit the claim for the ordered test before or after the physician has received or interpreted the results of the test.

If the physician who ordered the test has not received the results of the test, the patient's diagnosis code should reflect the signs and symptoms the patient presented with. Proper diagnosis coding requires you to code the reason the patient came in the door, not necessarily what you found when he got there, says Susan Callaway, CPC, CCS-P, an independent coding consultant in North Augusta, S.C.

On the other hand, if the physician who ordered the test receives and interprets the results of the test to determine a definitive diagnosis for the patient before the claim has been sent to the carrier, that physician should use a diagnosis code to represent the results of the test unless the results of the test are negative. Never use negative, or normal, test results as the reason for ordering the test. If the test does come back negative, code the signs and symptoms that prompted the physician to order the test.

According to CMS Program Memorandum AB-01-144, Medicare has taken the following stance on assigning diagnosis codes for diagnostic services:

If the physician has confirmed a diagnosis based on the results of the diagnostic test, the physician interpreting the test should code that diagnosis. The signs and/or symptoms that prompted ordering the test may be reported as additional diagnoses if they are not fully explained or are related to the confirmed diagnosis.

If the diagnostic test did not provide a diagnosis or was normal, the interpreting physician should code the signs or symptoms that prompted the treating physician to order the study.

If the results of the diagnostic test are normal or non-diagnostic, and the referring physician records a diagnosis preceded by words that indicate uncertainty (e.g., probable, suspected, questionable, rule out, or working), then the interpreting physician should not code the referring diagnosis. Rather, the interpreting physician should report the sign(s) or symptom(s) that prompted the study. Diagnoses labeled as "uncertain" are considered by the ICD-9-CM Coding Guidelines as unconfirmed and should not be reported. This is consistent with the requirement to code the diagnosis to the highest degree of certainty.

Apply the Basics to Bladder Scans

Diagnosis coding is one of the few activities when a complaint will actually get you somewhere.

Although many physicians feel the need to provide a definitive diagnosis when submitting a claim, there are many circumstances in which the symptom the patient presented with is the only thing they can find.

Let's suppose a patient presents with urinary incontinence, and the urologist orders a bladder scan. The results of the bladder scan confirm the presence of a urethral stricture. A urethral stricture, 598.9, is not a covered diagnosis for 51798, which means, if we follow the diagnosis coding guidelines for diagnostic tests, the urologist should report the signs and symptoms the patient presented with that motivated the urologist to order the bladder scan. Have the physician include any additional observations from the bladder scan in his office notes.

You are more likely to be reimbursed by Medicare as well as many third-party payers when you list symptoms or complaints as primary diagnosis codes for an evaluation, because a definitive diagnosis gives the carrier a reason to say, "No, we don't cover that service for that diagnosis," Callaway explains.

"Typically, payers expect signs and symptoms to justify diagnostic tests," says Morgan Hause, CCS, CCS-P, privacy and compliance officer for Urology of Indiana LLC, a 19-urologist practice in Indianapolis, "whereas a definitive diagnosis might prompt the payer to question why a diagnostic test was performed in the presence of a definitive diagnosis." This is also consistent with the requirement to code to the highest degree of specificity, he adds.

But if a patient presents with urinary incontinence, the urologist orders a bladder scan, and the results indicate there is residual urine, you should report the diagnosis code for the incontinence disorder as the primary diagnosis code and link it to 51798 and expect to be reimbursed.

One of the coding differences between bladder scans and diagnostic tests other than bladder scans is that with modern technology, i.e., the handheld devices that automatically print out and calculate the residual urine in the bladder, you don't have to worry about waiting for the results of the test to come in and this is always the case with 51798.

Don't immediately assume that you should refile your claim if it is denied for a noncovered diagnosis code. If it isn't listed in the carrier's list of covered diagnosis codes for 51798, they don't have to reimburse you.