Urology Coding Alert

For optimal reimbursement, urologists should use CPT 76775 (echography, retroperitoneal [e.g., renal, aorta, nodes], B-scan and/or real time with image documentation; limited) to bill post-void residuals (PVRs). According to the American Urological Association (AUA), 76775 is the correct code to use. Until recently, the AUA had recommended using either 76775 or 76857 (echography, pelvic [nonobstetric], B-scan and/r real time with image documentation; limited or follow-up [e.g., for follicles]).

Coding for PVRs

Post-void residuals are done to find out if a patient is retaining urine. If the patient is your patient, and you are in a global period for a procedure, you cannot charge at all for a PVR if it is related in any way to the initial procedure. If its completely unrelated, you can charge by appending modifier -79 (unrelated procedure or service by the same physician during the postoperative period) to the CPT code.

A urologist also can bill for PVRs if he or she was called in as a consultant on another physicians patient, says Mark Cendron, MD, professor of pediatrics and urology at Dartmouth Hitchcock Medical Center in Lebanon, N.H. You might need to perform a PVR after a neurological procedure, a gynecological procedure or an abdominal procedure such as resection of the sigmoid colon, says Cendron. You would need to do this whenever there is a possibility that bladder nerves are cut.

Of the three methods for coding PVRscatheterization, bladder scan or, more rarely, urodynamic testingthe bladder scan is the most controversial. For PVRs after the patient has voided, the urologist needs to determine how much urine is left in the bladder. This can be done by removing the urine via catheter and measuring it, or by looking at the bladder via ultrasonography to see how much urine is there. With urodynamic testing, the urologist puts pressure on the bladder to evaluate how much urine is left.

The standard method, catheterization, is coded 53670* (catheterization, urethra; simple) for commercial patients and for Medicare patients when performed in the hospital. For Medicare patients, when PVRs are done on an outpatient basis, code G0050. But for commercial patients, practices are using a variety of CPT codes.

76705 Pays Less

Some coders believe strongly that 76705 (echography, abdominal, B-scan and/or real time with image documentation; limited [e.g., single organ, quadrant, follow-up]) is the correct code to use. I tell our practices to use 76705 because that describes what is being done, says Pat Lawson, CPC, CCS-P, manager of documentation and coding for Urology Healthcare Group, a urology practice management company based in Franklin, Tenn. If you use 76775, that is retroperitoneal and includes the kidney and bladder. With PVRs, you only need to look at the bladder, says Lawson.

The problem with 76705, however, is that this code is for an intra-abdominal ultrasound, explains Ray Painter, MD, a urologist who is president of PRS, a coding and reimbursement consulting company based in Denver. The bladder would not be intra-abdominal. The most correct code at this time is 76775, says Painter, though 76857 is technically correct as well.

In addition, some experts recommend coding 78730 (urinary bladder residual study), though this is a nuclear medicine imaging code requiring special equipment and use of a radioelement of some type. This is not done in the office, however, and it is rarely done for PVR (except in the case of pediatrics).