Urology Coding Alert

Question: What is the correct billing for a volume study of the prostate gland? The urologist does this in the hospital outpatient department for patients with bladder obstruction and prostate cancer diagnoses. We have been using 76001, 76872, 51610, and 76965 with low reimbursement. We are mostly just being paid for 51610. What am I doing wrong?

Michigan Subscriber

Answer: For an approximation of prostatic size and volume, you should use 76872 (Ultrasound, transrectal) for measurement of the prostate gland volume/size, or use the ultrasonic measurement of the prostate gland during a bladder ultrasonic study: 76857 (Ultrasound pelvic [nonobstetric], real time with image documentation; limited or follow up...).

For a more exact measurement of prostate volume for radiation planning for cancer of the prostate, use 76873 (Prostate volume study for brachytherapy treatment planning [separate procedure]) instead.