Urology Coding Alert

Question: Medicare plans have been denying our claims for 51798 billed with a diagnosis of recurrent UTIs. I cannot find a local coverage determination (LCD) about this. What diagnoses should we be reporting?

Wisconsin Subscriber

Answer: Many payers (including Medicare) do not accept diagnoses of recurrent UTI such as N39.0 (Urinary tract infection, site not specified) or Z87.440 (Personal history of urinary [tract] infections) as appropriate for a bladder scan (51798, Measurement of post-voiding residual urine and/or bladder capacity by ultrasound, non-imaging). The reason for denials is that most urologists will not order a bladder scan simply because of a UTI or a history of UTI.

You should always code procedures and diagnoses based on your provider’s documentation, not what you think will be paid by the insurer. That being said, a few diagnoses that might be more acceptable in conjunction with bladder scan (with supporting documentation) include: 

• N13.9 – Obstructive and reflux uropathy, unspecified
• N32.0 – Bladder neck obstruction 
• N32.81 – Overactive bladder 
• N39.3 – Stress incontinence (female) (male)
• N39.42 – Incontinence without sensory awareness
• N39.498 – Other specified urinary incontinence
• R33.8 – Other retention of urine
• R39.14 – Feeling of incomplete bladder emptying.