Urology Coding Alert

Reader Question:

Link Bladder Scans to Most Accurate ICD-9 Codes

Published on Wed Jan 01, 2003

Question: I am confused about which diagnosis codes Medicare considers covered for bladder scans measuring post-void residual urine, G0050. Is there a list of the ICD-9 codes somewhere that I can use as a reference?

Alabama Subscriber

Answer: Don't just scan your carrier's list of diagnosis codes when you are submitting a claim for G0050 or you could find that your "foolproof" ICD-9 codes for bladder scans weren't foolproof after all.

The first thing you have to remember about diagnosis coding for a bladder scan, in this case G0050 (Measurement of post-voiding residual urine and/or bladder capacity by ultrasound) for a Medicare patient, is that deciding which ICD-9 codes are reimbursable is under the carriers'discretion.

For example, Empire Medicare services for New Jersey lists the following diagnosis codes as covered:

595.9 Cystitis, unspecified

596.3 Diverticulum of bladder

596.4 Atony of bladder

596.54 Neurogenic bladder NOS

599.0 Urinary tract infection, site not specified

599.7 Hematuria

600.0 Hypertrophy (benign) of prostate

600.2 Benign localized hyperplasia of prostate

625.6 Stress incontinence, female

788.20 Retention of urine, unspecified

788.21 Incomplete bladder emptying

788.29 Other specified retention of urine

788.30 Urinary incontinence, unspecified

788.31 Urge incontinence

788.32 Stress incontinence, male

788.33 Mixed incontinence, (male) (female)

788.34 Incontinence without sensory awareness

788.35 Post-void dribbling

788.36 Nocturnal enuresis

788.37 Continuous leakage

788.39 Other urinary incontinence

788.41 Urinary frequency

788.42 Polyuria

788.43 Nocturia

788.5 Oliguria and anuria

788.61 Splitting of urinary stream

788.62 Slowing of urinary stream

788.69 Other

788.9 Other symptoms involving urinary system.

Whenever you do a diagnostic test, the diagnosis code linked to the test should be the findings of the test unless the results of the test are negative, in which case the signs or symptoms that prompted the exam should be reported as the ICD-9 code(s).

For example, a 70-year-old female patient presents with persistent urinary incontinence, and the urologist orders a bladder scan. The results of the bladder scan are negative and there is no residual urine, so the diagnosis code that should be linked to the bladder scan, G0050, is 788.33 (Mixed incontinence, [male] [female]). But if the results of the bladder scan positively identify an incontinence disorder, report the results as the primary diagnosis code.

You should also be careful when you report a "result" of the bladder scan as the diagnosis code. For example, if your urologist orders a bladder scan for a patient and the bladder scan reveals a urethral stricture, not otherwise specified (NOS), 598.9, you won't be reimbursed for G0050 because the diagnosis code does not support the procedure. Instead, you will need to report the signs or symptoms that make up the reason for the bladder scan. Definitely include any additional observations from the bladder scan in the office notes; just don't try to bill based on nonpertinent test results.

If one of your claims for G0050 is denied due to the reporting of a noncovered diagnosis code, this does not mean you should automatically refile, especially if the diagnosis code you reported is clearly not listed in the carrier's LMRPlist of covered ICD-9 codes for G0050.

Be aware that as of Jan. 1, 2003, HCPCS code G0050 has been deleted and is replaced by a new CPT code, 51798 (Measurement of post-voiding residual urine and/or bladder capacity by ultrasound, non-imaging). So, for Medicare, 51798 will replace G0050 in 2003, but whether all carriers will recognize and use the new CPT code and for what diagnoses can't be determined until the new year.