What you think you know can hurt you to the tune of $15 per patient
In 2003, CPT Codes introduced code 51798 to replace a temporary G code to report bladder scans by ultrasound - and it has vexed coders ever since. The procedure, which earns about $15 each time based on unadjusted RVUs, is one of the most commonly performed in urology practices. And confusion about when it's appropriate to report 51798 (Measurement of post-voiding residual urine and/or bladder capacity by ultrasound, non-imaging) and what you're allowed to report with it could cost your practice a significant total.
Understanding the truth behind these six myths about 51798 coding will help make sure you're not leaving any postprocedure residual money on the table.
Myth #1: Whether the urologist takes an image during the bladder scan determines what code to use. If he doesn't take an image, report 51798. If he does take an image, report 76775 (Ultrasound, retroperitoneal [e.g., renal, aorta, nodes], B-scan and/or real time with image documentation; limited).
Reality: Confusion on this point is common, especially since "non-imaging" appears right in the CPT Code descriptor for CPT 51798 . But whether or not the urologist obtains images is inconsequential. The use of the proper CPT code depends on the reason for the sonogram. The Coding and Reimbursement Committee of the American Urological Association reviewed this issue and decided, "regardless of the type of ultrasound machine used or whether an image was obtained, if the intent of the diagnostic procedure is to obtain only a postvoiding residual urine, then CPT code 51798 is appropriate."
Solution: If the urologist does the bladder sonogram primarily to determine the postvoid residual urine (PVR), use 51798 no matter what equipment the urologist uses and whether or not he derives an image from the equipment, says Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology at State University of New York, Stony Brook.
If the urologist uses the sonogram primarily to view the anatomy or architecture of the bladder, and the PVR is only part of - but not the main reason for - the study, bill 76775.
"The AUA and the American Medical Association have recommended code 76775 because this is a retroperitoneal study, and the bladder is a retroperitoneal organ," Ferragamo says.
Beware: The second instance is the only circumstance in which you should bill 76775. Most urologists do a bladder sonogram primarily for PVR determination and should be billing with 51798. "You may also use code 76857 (Ultrasound, pelvic [nonobstetric], B-scan and/or real time with image documentation; limited or follow-up) when the urologist views the anatomy or architecture of the bladder," Ferragamo says.
Myth #2: You can't bill for [...]