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New residual urine code will be for non-imaging US only
Written by Ray Painter   
Saturday, 01 February 2003

 

 

Q How do I charge for a bladder scan for residual urine using the new 2003 CPT code (51798 ) if I am using an "imaging" ultrasound?

 

A Instructions for the new code, 51798, specifically state that it is to be used for a non-imaging ultrasound exam for residual urine. In the 2003 Medicare fee schedule, there is no specific code for using an imaging ultrasound to check for residual. Therefore, after March 1, use 76775, ultrasound, retroperitoneal, limited.

 

Do not use the new codes until implementation of the 2003 Medicare fee schedule on March 1. Until then, continue to use G0050. A complete discussion will be included in next month's issue of Urology Times.

 

Q Our insurance companies are slashing our reimbursements for drugs. Can we bill the patient for triplicate scripts? If so, is there a code, or what is the going rate?

 

A The amount you are paid for drugs, supplies, and other services can only be addressed through your contract with the insurance company. You cannot charge more for one service to make up for low payment from another service.

 

One cannot charge for writing a prescription (including "triplicate scripts"). This service is included in your E&M service as part of "Medical Decision Making."

 

Q According to the Medical Record Chart Analyzer by Deborah J. Grider (published by the AMA in 2000), "A written request for opinion or advice received from an attending physician, including the specific reason the consultation is required," is one of three requirements needed for a new patient visit to qualify as a consultation. According to Pharmacia reimbursement specialists, a patient's statement about his/her referral, documented by a consulting physician, is sufficient. Please advise.

 

A A written request from the referring physician is not required to charge a consult.

 

The 1999 modification of the guidelines for consult charges clearly stated in the documentation that a request for a consult needed to be documented by the consultant. The Medicare Carriers Manual, the official communication from CMS to the Medicare carriers, instructs the carriers on how to interpret and apply the documentation and payment rules. The carrier's manual states that the consultant must document the referring physician and the reason for the consult.

 

Specifically, the manual does not include any requirement for the consultant to have a written request from the referring physician in their chart.

 

In other words, if you are going to charge a consult, you, the consultant, must document who referred the patient and the reason for the consult. Therefore, if you're convinced that that patient was sent to you by another physician, put in writing "this patient was sent by 'Dr. X' for 'XYZ problem.'" That statement will satisfy the requirements for a consult.

 

See previous articles (Urology Times, February 2002, page 38; March 2002, page 24) for more details.

 

Unfortunately, many consultants continue to apply old rules. Also, be aware of misinformation that is printed. Just because it appears in a newsletter or a book or is stated by a consultant doesn't necessarily mean that it is correct. At times, we also receive wrong answers from our carriers.

 

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.

 

 

 

 


 
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