Urology Coding Alert

You can bill a distinct E/M visit separate from 51798

If you don't know the nuances of bladder scan coding, you could be missing out on reimbursement your urologist should be receiving for this service. Here are three common misconceptions that could be costing you money.

Myth #1: Always Use an Ultrasound Code

If you believe you should bill a particular ultrasonic CPT code if your urologist used an  ultrasonic device to perform the bladder scan, you  may land yourself in hot water.

Reality: If the sole purpose of the scan 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 urologist positions any ultrasonic scanner over the suprapubic area to measure the residual urine. 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 urologist 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 actual results of the test.

Example: Your urologist 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 urologist either includes the report from the machine or documents the test and results in detail. Then, report 51798 and 51702 (Insertion of temporary indwelling bladder catheter; simple [e.g., Foley]). You don't need any modifiers when you use these two codes together because 51798 is a radiological code and 51702 is a surgical code.

Myth #2: Avoid Separate E/M Service

Thinking you can never bill an evaluation and management visit when you report 51798 means that you could be costing your practice money it rightfully deserves.

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, 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, 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. 

Helpful: The American Urological Association (AUA) also offers an appeal letter to send to carriers that deny claims of 51798 with an E/M service. You can download it from www.auanet.org/coding/reimburse/appeal/empvr.pdf.

Myth #3: Report Urologist's Interpretation Only for Off-Site Scans

You may use the guideline that you can code separately for the interpretation of the study if someone else performs the bladder scan off-site.

Reality: Because code 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 urologist reads the results after a separate facility performs the actual measurement, you should include the professional interpretation of the study in your documentation of the medical decision-making portion of your E/M service. Bill only for your E/M services for the day, which would include the urologist's reading the sonogram.

Alternative: If the urologist 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 using modifier 26 appended to the above codes if the urologist alone and not the radiologist does the interpretation of the studies.