procedure code and description
51798– Us urine capacity measure – average fee payment- $20 – $30
procedure code 51702 Insertion of temporary indwelling bladder catheter; simple (e.g., Foley)
• procedure code 51705 Change of cystostomy tube; simple
• procedure code 51798 Measurement of post-voiding residual urine and/or bladder capacity by ultrasound, non-imaging
52000– Cystourethroscopy (separate procedure) – average fee payment – $200 – $230
Report code 52000 when the criteria outlined for one of these two scenarios are met:
1.A complete cystouretheroscopy is performed by the physician utilizing the Percuvision technology.
2.Medical necessity for a uretheroscopy such as a history of difficult c theterizations, abnormal anatomy, or a recent difficult catheterization. In this case, if only the catheterization was performed using visualization, code 52000 should be reported with a modifier -52 (reduced services) to indicate that the full cystouretheroscopy was not performed. Some payers will require documentation with the use of the -52 modifier.
Other Applicable Codes
51702 Insertion of temporary indwelling bladder catheter; simple (eg, Foley)
51703 Insertion of temporary indwelling bladder catheter; complicated (eg, altered anatomy, fractured catheter/balloon)
Coverage Indications, Limitations, and/or Medical Necessity
Post-voiding residual (PVR) urine volume is the volume in the bladder immediately after the completion of voiding. The standard method of determining PVR urine volumes is intermittent catheterization, which is associated with increased risk of urinary infection, urethral trauma and discomfort for the patient. Bladder ultrasound has been introduced as an alternative, noninvasive method, to avoid the potential complications of intermittent catheterization.
The use of ultrasound to determine PVR is considered medically necessary and reimbursable for the following indications:
To assess urinary retention
To assess incomplete bladder emptying
To assist with bladder re-training by determining the need to void based on bladder volume
To determine actual bladder volume in patients who have incomplete bladder emptying and require frequent catheterizations to drain the bladder
PVR ultrasound is not considered to be medically necessary when performed for routine screening purposes or when no treatment is planned regardless of the finding.
Bill Type Codes
Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the policy does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the policy should be assumed to apply equally to all claims.
Procedure /HCPCS Codes
51798 Us urine capacity measure
ICD-10 Codes that Support Medical Necessity 51798
G83.4 Cauda equina syndrome
N13.9 Obstructive and reflux uropathy, unspecified
N23 Unspecified renal colic
N31.0 Uninhibited neuropathic bladder, not elsewhere classified
N31.1 Reflex neuropathic bladder, not elsewhere classified
N31.2 Flaccid neuropathic bladder, not elsewhere classified
N31.9 Neuromuscular dysfunction of bladder, unspecified
N39.3 Stress incontinence (female) (male)
N39.41 Urge incontinence
N39.42 Incontinence without sensory awareness
N39.43 Post-void dribbling
N39.44 Nocturnal enuresis
N39.45 Continuous leakage
N39.46 Mixed incontinence
N39.490 Overflow incontinence
N39.491 Coital incontinence
N39.492 Postural (urinary) incontinence
N39.498 Other specified urinary incontinence
N40.1 Benign prostatic hyperplasia with lower urinary tract symptoms
R30.1 Vesical tenesmus
R30.9 Painful micturition, unspecified
R32 Unspecified urinary incontinence
R33.0 Drug induced retention of urine
R33.8 Other retention of urine
R33.9 Retention of urine, unspecified
R34 Anuria and oliguria
R35.0 Frequency of micturition
R35.8 Other polyuria
R36.0 Urethral discharge without blood
R36.9 Urethral discharge, unspecified
R39.0 Extravasation of urine
R39.11 Hesitancy of micturition
R39.12 Poor urinary stream
R39.13 Splitting of urinary stream
R39.14 Feeling of incomplete bladder emptying
R39.15 Urgency of urination
R39.16 Straining to void
R39.191 Need to immediately re-void
R39.192 Position dependent micturition
R39.198 Other difficulties with micturition
R39.2 Extrarenal uremia
R39.81 Functional urinary incontinence
R39.82 Chronic bladder pain
R39.89 Other symptoms and signs involving the genitourinary system
R39.9 Unspecified symptoms and signs involving the genitourinary system
CMS’ Final Decisions on the August 2012 Recommendations of the Hospital Outpatient Payment Panel on Supervision Levels for Select Services
In the Calendar Year (CY) 2012 Outpatient Prospective Payment System /Ambulatory Surgical Center (OPPS/ASC) Final Rule, the Centers for Medicare & Medicaid Services (CMS) established a process to obtain independent advice from the federal advisory Hospital Ou patient Payment Panel (the Panel) regarding the appropriate supervision levels for individual hospital outpatient therapeutic services (76 FR 74360). Accordingly, at its meeting on August 27-28, 2012 the Panel evaluated and made recommendations to CMS regarding 29 services. We then posted for public comment CMS’ preliminary decisions on the required supervision for these services, based on the Panel’s recommendations. Having considered the public comments that we received, following are our final decisions for the required supervision levels.
Effective January 1, 2013, 22 of the considered services may be furnished with a minimum of general supervision and the remaining 7 services will maintain their current designation as nonsurgical extended duration therapeutic services (extended duration services or NSEDTS*). A complete list of the services that may be furnished under general supervision or that are designated as NSEDTS is available on the CMS Website at http://www.cms.gov/Medicare/Medicare-Fee- orServicePayment/HospitalOutpatientPPS/index.html?redirect=/HospitalOutpatientPPS/01_overview.asp.
In particular, as we proposed the following services may be furnished under a minimum of general supervision.
• HCPCS code G0008 Administration of influenza virus vaccine
• HCPCS code G0009 Administration of pneumococcal vaccine
• HCPCS code G0010 Administration of hepatitis B vaccine
• HCPCS code G0127 Trimming of dystrophic nails, any number
• Procedure code 11719 Trimming of nondystrophic nails, any number
• Procedure code 36000 Introduction of needle or intracatheter, vein
• Procedure code 36591 Collection of blood specimen from a completely implantable venous access device
• Procedure code 36592 Collection of blood specimen using established central or peripheral catheter, venous, not otherwise specified
• Procedure code 51702 Insertion of temporary indwelling bladder catheter; simple (e.g., Foley)
• Procedure code 51705 Change of cystostomy tube; simple
• Procedure code 51798 Measurement of post-voiding residual urine and/or bladder capacity by ultrasound, non-imaging
• Procedure code 96360 Intravenous infusion, hydration; initial, 31 minutes to 1 hour
• Procedure code 96361 Intravenous infusion, hydration; each additional hour (list separately in addition to code for primary procedure)
• Procedure code 96521 Refilling and maintenance of portable pump
• Procedure code 96523 Irrigation of implanted venous access device for drug delivery systems
Pediatric and Neonatal Critical Care – Codes 36000, 36140, 36620, 36510, 36555, 36400, 36405,
36406, 36420, 36600, 31500, 94002, 94003, 94004, 94375, 94610, 94660, 94760, 94761, 94762,
36430, 36440, 43752, 51100, 51701, 51702 and 62270 are considered incidental to 99468, 99471 and
99475(Inpatient Neonatal and Pediatric Critical Care). The critical care procedure codes listed as a part of
99291 and 99292 are included in the Pediatric Neonatal Critical care and are considered incidental.
Separate reimbursement is not allowed for incidental services
Q: Can I bill cystoscopy (52000) as a separate procedure?
A: No, cystoscopy is an included component in both the CPT and HCPCS codes used for reporting the transprostatic implant procedure.
Q: How much will insurers pay for the transprostatic implant procedure?
A: Medicare is the only insurer with publicly available fee schedules. You may want to contact your non-Medicare insurers to determine payment levels for CPT codes 52441 and 52442 and/or HCPCS codes C9739 and C9740. Please see the Physician Coding and Hospital Outpatient Coding sections of this Billing Guide for the national unadjusted Medicare RVUs and payment and the APC assignments and payments. Medicare reimbursement levels will vary geographically. Consult your Medicare carrier’s website for more information.
CPT/HCPCS Action – payment guidelines
20245 Global Days = 000
52441 Endo Base = 52000
64897 Co-Surgery = 1
64902 Co-Surgery = 1
J1725 Status = I, effective for DOS on or after July 1, 2017
P9072 Status = I, effective for DOS on or after July 1, 2017