Urology Coding Alert

Other limited anatomical reviews won’t support 76770 coding, however.

More and more urologists are beginning to perform their own ultrasound studies rather than referring the patient to a radiologist. When your urologist uses ultrasonic imaging to visualize the main structures of a patient’s urinary system, make sure you dig into the details to determine the proper code to use.

Your code choice often depends on the extent of the evaluation of the urinary system – but there is an exception to the rule. Read on to ensure you know how to properly select the radiology codes for your urologist’s work.

Capture Complete US for Just Kidney and Bladder

Before choosing an ultrasound code for imaging of urinary structures, be sure to read the CPT^® guidelines. You may be surprised by which codes apply to the different studies.

For patients with a clinical history suggesting urinary tract pathology, complete evaluation of the kidneys and urinary bladder supports coding a complete retroperitoneal ultrasound, said Michael A. Ferragamo, MD, FACS, clinical assistant professor at the State University of New York at Stony Brook, in a recent presentation for AudioEducator.com.

You’ll find this rule in the CPT^® guidelines. The proper code is 76770 (Ultrasound, retroperitoneal [e.g., renal, aorta, nodes], real time with image documentation; complete).

This urinary tract pathology exception is important because otherwise 76770 would require “real time scans of the kidneys, abdominal aorta, common iliac artery origins, and inferior vena cava, including any demonstrated retroperitoneal abnormality,” CPT^® guidelines state.

Diagnosis: Diagnoses that may support a clinical history of urinary tract pathology include (but aren’t limited to):

·         Dysuria and painful urination (ICD-9: 788.1, Dysuria; ICD-10: R30.0, Dysuria; R30.9, Painful micturition, unspecified)

·         Frequent urination and polyuria (ICD-9: 788.4x, Frequency of urination and polyuria; ICD-10, R35.-, Polyuria)

·         Flank pain (ICD-9: 789.0x, Abdominal pain; ICD-10: R10.-, Abdominal and pelvic pain).

Keep Complete/Limited in Mind for Kidneys

Having established that coding guidelines allow you to report a complete retroperitoneal code 76770 for imaging of the kidneys and bladder in certain patients and for certain clinical scenarios, raises the question of proper coding for ultrasound of only the kidneys or only ultrasound of the bladder. Let’s start with ultrasonic examination of only the kidneys.

CPT^® guidelines state, “If less than the required elements for a ‘complete’ exam are reported (e.g., limited number of organs or limited portion of region evaluated), the ‘limited’ code for that anatomic region should be used once per patient exam session.”

A logical assumption is that if the complete retroperitoneal code applies to the kidneys and bladder, then the limited code applies to ultrasound of only the kidneys.

In the case of kidneys, that assumption is correct. Note the use of the term “renal” in the definition of 76775 (Ultrasound, retroperitoneal [e.g., renal, aorta, nodes], real time with image documentation; limited). Renal means related to the kidneys. So for ultrasound of the kidneys only, you should report 76775.

Look Beyond 76775 for Bladder Imaging

Although the limited retroperitoneal code is appropriate for ultrasound of the kidneys only, you should not use a retroperitoneal code for imaging of just the bladder anatomy, Ferragamo says.

Instead, you should use limited pelvic ultrasound code 76857 (Ultrasound, pelvic [nonobstetric], real time with image documentation; limited or follow-up [e.g., for follicles]). CPT^® guidelines state that “Code 76857, rather than 76770, should be utilized if the urinary bladder alone (i.e., not including the kidneys) is imaged.”

Tip: “Documentation of a bladder ultrasound should include measurements of the thickness of the bladder wall, the presence of any diverticula (small outpocketings through the bladder wall), any stones present within the diverticula, the bladder interior including presence of any tumors or stones, and for male patients demonstration of an enlarged prostate gland deforming the bladder floor and base,” Ferragamo says.

Pitfall: If your urologist is performing the bladder ultrasound to determine post voiding residual bladder urine volume (PVR) and not for bladder anatomy, report 51798 (Measurement of post-voiding residual urine and/or bladder capacity by ultrasound, non-imaging) instead of 76857 even if ultrasound images obtained from standard ultrasonic equipment are used to calculate/determine the residual urine. “Often the PVR is obtained by a small hand held Doppler scanner passed over the lower abdomen,” Ferragamo explains. “In the latter case, also code 51798.”