Sorry, I'm way late to the party on this one - but I was just asked about a problem billing 51798 by a client. Just like you, tmclaughlin, my client said they are only getting paid for the technical component.
The first thing I checked was my online coding resource, EncoderPro. I pulled up 51798, and sure enough, there is a note which states:
"This code represents the technical component only with no associated physician involvement."
So why is the note there? I have a theory. After researching the August
2012 AMA/RUC Comments to CMS, It appears that the RUC (Relative Value Scale Update Committee) assigned physician time to CPT code 51798 when it was implemented in 2003, and hence they assigned work RVU's to the code, since urologists typically perform the service. However, CMS disagreed in the 2003 Medicare Final Rule and assigned only practice expense. Just recently, CMS removed the physician time from the code at the RUC's recommendation - so it truly doesn't report physician services, even though it was originally intended to before CMS disagreed.
That seems to indicate to me that there are no physician work RVU's included in this procedure. Hence, it makes sense that any physician work can be reported with an E/M code. You wouldn't think a modifier -25 would be needed, since the global concept doesn't apply to this code, but maybe some insurances require it anyway.
Here's some supporting info I found from the
Coding Corner of the American Urological Association's website:
Bladder Scan Confusion: If the physician’s intent is to obtain post-void residual urine, which code should my office be using?
Current Procedural Terminology (CPT®) code 51798 was established to capture the measurement of post voiding residual urine and/or bladder capacity by ultrasound, non-imaging. A hand-held doppler unit is used to perform this measurement of the bladder. The small transducer is passed across the abdomen. The transducer emits and detects high-pitched sounds beyond the range of human hearing. The sound waves are reflected back from the structures in the body and are converted into a picture. This type of unit will print out the volume and draw a graph of the bladder or provides some other printed report. This is not considered an “ultrasound image.” When performing a post-voiding residual (PVR) using a hand-held unit with a simple printout, use CPT® code 51798 for Medicare and commercial carriers.
In the Medicare reimbursement system, CPT® code 51798 has a XXX global indicator. This means that the global concept does not apply to this code. This same indicator applies to many radiological procedures. It can be performed at the same time as an evaluation and management service and should not be bundled. Some carriers are denying CPT® 51798 even though it is not subject to the bundling rules.
