Urology Coding Alert

How do you bill for a bladder scan and an office visit together, and should you use modifier -25 (significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service)?

When billing an office visit along with a bladder scan (G0050 for Medicare patients, 76775 or 76857 for commercial patients), it is not necessary to append a modifier -25. In fact, using it could just confuse the payer, because then they might start looking for a different diagnosis or at least a different complaint for the two services.

Neither Medicare nor commercial payers require modifiers for an E/M service and a radiology procedure, says Sandy Page, CPC, CCS-P, co-owner of Medical Practice Support Services, a coding, compliance and reimbursement consulting firm in Denver.

In essence, G0050 (measurement of post-voiding residual urine and/or bladder capacity by ultrasound) is already bundled with an office visit anyway. There is no work value assigned to G0050, only a technical component. You are only getting paid for having the hand-held scanner which measures the residual urine; there is no reimbursement for interpreting the result.

You dont need to use a modifier on an E/M service with any type of ultrasound, says Jackie Shovan, CPC, a financial counselor with the division of urology at the University of Utah in Salt Lake City. Insurance will pay on any type of ultrasound with an E/M, with no modifier -25.

The American Medical Association (AMA) recommends using code 76775 (echography, retroperitoneal [e.g., renal, aorta, nodes], B-scan and/or real time with image documentation; limited) for the bladder scan; while the American Urological Association (AUA) recommends 76857 (echography, pelvic [nonobstetric], B-scan and/or real time with image documentation; limited or follow-up [e.g., for follicles]). Either one is correct.

Some urology coders are incorrectly billing 76705 (echography, abdominal, B-scan and/or real time with image documentation; limited (e.g., single organ, quadrant, follow-up). This is possibly an artifact from the days about a decade ago when the hand-held device first began to be marketed to urologists. The representatives told billers to use 76705 to get paid for using the scanner. This was incorrect, partly because the bladder is not an abdominal organ.