Did you know that post-void residual urine scan plays an integral role in the treatment of conditions, such as blockage in the urinary tract, enlarged prostate, narrowed urethra, and medication side effects?
Thus, understanding how to bill for these scans is essential for urology clinics and urologists.
This guide will cover everything you need to know about one such procedure covered under CPT code 51798. We will discuss its descriptor, share real-world clinical scenarios, applicable modifiers, and reimbursement guidelines.
So, if this is something you have been looking for lately, continue reading!
CPT Code 51798 – Description
CPT code 51798 covers a urodynamic procedure to measure post-void residual (PVR) using a non-imaging ultrasound device. For context, PVR is the amount of urine that remains in the bladder immediately after urination.
Appropriate Use Cases for CPT Code 51798
Let’s review a few real-world clinical scenarios where CPT 51798 applies:
Benign Prostatic Hyperplasia (BPH) Management
Picture a 64-year-old male patient who comes to see the urologist. He complains about experiencing a sensation of incomplete emptying, a weak stream, and worsening urinary frequency.
Thus, the urologist performs a physical exam and then asks the patient to void. Immediately after, the provider conducts a bedside bladder ultrasound using a portable scanner to measure the volume of urine remaining in the bladder.
The measurement reveals 250 mL of residual urine. This confirms significant urinary retention secondary to BPH.
Here, CPT code 51798 applies.
Neurogenic Bladder Evaluation
Consider a 47-year-old female patient with a history of multiple sclerosis. During the visit to the clinic, she shares details about experiencing recent episodes of urinary incontinence with the physician.
Thus, the clinician performs a non-imaging ultrasound post-void, which is covered under CPT code 51798. The focus remains on determining whether the patient is experiencing overflow incontinence due to a neurogenic bladder.
The scan shows a PVR of 300 mL. This indicates that the bladder is not contracting effectively.
Recurrent Urinary Tract Infections (UTIs) Assessment
Imagine a 29-year-old female patient who presents to the clinic with her fourth UTI in the past 12 months. The physician suspects that urine sitting in the bladder for too long (urinary stasis) is the contributing factor for recurrent UTIs.
Therefore, once the patient provides a clean-catch urine sample, the physician uses a bladder scanner to look for residual volume post-void.
The scan shows a minimal PVR of 10 mL. This suggests that the UTIs are likely not caused by an emptying dysfunction.
However, the biller should report CPT code 51798 to bill for the evaluation of post-voiding residual urine in the bladder by ultrasound.
Modifiers to Append with CPT Code 51798
Discussed below are the applicable modifiers for CPT 51798:
Modifier 59 or X{EPSU}
What happens when the bladder scan (CPT code 51798) is distinct from other services performed on the same day? You append modifier 59 or its more specific subset X{EPSU} modifiers depending on payer policies.
Here are common scenarios where these more specific X modifiers apply:
- XE (Separate Encounter): It highlights that the scan was performed at a different time of day than the main procedure.
- XP (Separate Practitioner): It indicates that a different provider performed the bladder scan than the one who performed the bundled service.
- XS (Separate Structure): It represents that the scan was performed on the bladder when the main procedure involved a different organ.
- XU (Unusual Non-Overlapping Service): When this modifier is on the claim, it means that the usual components of the scan do not overlap with the main procedure.
Reimbursement Guidelines for CPT Code 51798
The following are the key billing requirements for CPT 51798:
Establish Medical Necessity
Justifying the medical necessity of the rendered bladder scan is integral to ensuring timely reimbursement.
Thus, your documentation should include the covered diagnoses. Some of the acceptable clinical indications for CPT code 51798 are as follows:
- R33.8: Urinary retention
- R39.11: Hesitancy of micturition
- N31.9: Neurogenic bladder +*–
- N40.1: BPH with lower urinary tract symptoms
Note that scans performed as part of routine screening without symptoms are often denied.
Fulfill Documentation Requirements
Detailed documentation is key to the timely processing of your claim for CPT code 51798.
Thus, here’s what it should include:
- Explicitly state that the patient voided immediately before the measurement. It is an essential requirement since it distinguishes PVR from a general bladder capacity measurement.
- Explain that you obtained the volume via non-imaging ultrasound. If a standard ultrasound machine is used to calculate residual urine volume from the imaging, CPT code 51798 does not apply (report CPT 76775 instead).
- Document the actual volume measured in milliliters (mL).
- Record a brief statement on how the result impacts the patient’s care. For example, a PVR of 250 mL indicates significant retention.
Understand the Frequency Limitation
While billing for CPT code 51798, you must understand that most Medicare Administrative Contractors (MACs) and commercial insurance carriers have frequency limitations. That is, you can only perform it once per day per beneficiary.
Thus, if you try to bill it more than once for a single date of service, it will trigger a denial.
Final Thoughts on CPT Code 51798
To summarize, CPT code 51798 covers the measurement of post-voiding residual urine in the bladder using non-imaging ultrasound.
However, if you use a standard ultrasound machine and calculate residual urine volume from imaging, there is another more relevant CPT code available for it, i.e., CPT 76775.Hopefully, this guide will help you streamline billing for urodynamic procedures. However, if you still struggle, feel free to acquire urology billing services from professionals, like NeuraBill.
