AUA recommends 51798 any time ultrasound is performed to check for residual urine

Q We use the BVI-3000 BladderScan from Diagnostic Ultrasound for residual urine. They show a shadow of amount left in the bladder on a printed report. Is this still considered a non-image? Is there any way we can use 76775 using the BVI-3000?

A 76775 is the appropriate code to use for a B scan or real-time ultrasound image, according to CPT. However, AUA has specifically stated that it recommends using code 51798 any time ultrasound is performed to check for residual urine.

Q Regarding your article in the February 2003 issue of Urology Times ("New residual urine code will be for non-imaging US only," page 40), you recommend billing CPT 76775 for imaging ultrasounds for post-void residual. However, the Virginia Local Medical Review Policy states that the use of handheld ultrasonic devices to determine post-void residual bladder volume is not reimbursable by this code. What should the dictation include to substantiate charging CPT 76775 for PVR?

A First, see the discussion above for coding recommendations. "Handheld" was probably intended to imply non-imaging.

The dictation to substantiate 76775 should include a complete separate dictation, official radiological style, to include the architecture of the bladder, the bladder wall, etc. The complete pelvic organs do not need to be discussed, since this is a limited exam. The report should be separate from your office progress note or operative note.

Important update: Coding of residual ultrasound

In my February 2003 column (page 40), I discussed the new 51798 ultrasound code and the fact that CPT had specifically stated it applied to non-imaging. I also discussed the difference between imaging and non-imaging ultrasound, according to the CPT definition, and provided the appropriate coding for checking residual urine according to CPT definition and current CMS rules. There was a strong recommendation to keep an eye out for a CMS directive or local carrier medical review policy (LMRP) that would crosswalk the original G0050 code to the 51798, again directing us to use 51798 code for checking residual regardless of the type of ultrasound being used.

At the AUA annual meeting, the Health Policy council recommended that, if the intent of your exam is to check residual urine, then you should use the 51798 code whether you are using an imaging or non-imaging machine. The council felt that the radiological (76775 or 76857) code should be reserved for exams in which the intent was to ultrasound the bladder wall.

In those cases, the bladder would be purposefully filled with fluid or urine as opposed to being "post-void." If one performs an ultrasound post-voiding and there is no residual urine, one cannot adequately check the bladder wall, etc.

According to AUA, recommended coding would be 51798 for the check of residual urine for both the imaging and non-imaging machine. My recommendations are to follow the AUA's recommendations.

Follow the hierarchy

There is a hierarchy of how urologists should use rules to report their services.

• If CMS has a directive or the carrier has an LMRP addressing the appropriate coding for a service, that supersedes CPT and all other rules.
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• If there is no specific LMRP or directive, then the CPT rules are to be followed.
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• If your specialty society issues an opinion, these should be primarily considered.
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• If you follow AUA opinions/recommendations, there should be no accusations of fraud because you have reasons to believe that is the correct interpretation.
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I personally recommend the reporting of services in the hierarchy as mentioned above. If AUA suggests any particular coding, then I recommend that you follow those rules.

Disclaimer: The information in this column is designed to be authoritative, and every effort has been made to ensure its accuracy at the time it was written. However, readers are encouraged to check with their individual carrier or private payers for updates and to confirm that this information conforms to their specific rules.

Disclaimer: The information in this column is designed to be authoritative, and every effort has been made to ensure its accuracy at the time it was written. However, readers are encouraged to check with their individual carrier or private payers for updates and to confirm that this information conforms to their specific rules.