Is 51798 appropriate for billing postvoid residual measured by catheterization?

When my provider is doing urodynamic studies, they are documenting “Post Void Residual Urine: Residual urine is 15 ml measured by urethral catheterization.” The code that has been sent over is 51798; however, that states by “ultrasound, non-imaging.” I am fairly new to this coding and wondering if another code better supports the postvoid residual [PVR] urine in this scenario or if nothing is billed for this type of case. I believe the 51798 is not supported here.

Jonathan Rubenstein, MD

First of all, welcome to this coding thing and glad to have you on board. We always appreciate excellent questions, especially those that are asked with insight. We always encourage people to ask advice, especially when something doesn’t pass the “sniff test.”

CPT 51798 describes Measurement of post-voiding residual urine and/or bladder capacity by ultrasound, non-imaging. This means that an external device, usually a hand-held or portable machine that will give an estimate of the urine remaining in the bladder, is used to obtain the necessary data. (And also note that even if an

Mark Painter

imaging device was used to capture the residual, if the goal of the test is to check for bladder urine volume, CPT code 51798 should be used as opposed to an ultrasound code.)

When placing a catheter to check a residual urine volume, whether it be performed by a straight catheter or a urodynamics catheter, CPT 51701 Insertion of non-indwelling bladder catheter (eg straight catheterization for residual urine) is the appropriate code to use. However, in the case of performing a concomitant urodynamics study, CPT 51701 is bundled to the urodynamics codes and cannot be billed separately. Determining the PVR as part of a urodynamics test is part of the test itself and included in the payment already.

Rubenstein is compliance officer and medical director of coding and reimbursement, United Urology Group and Chesapeake Urology, Towson, Maryland. Painter is CEO of PRS Urology SC in Denver, Colorado.

Send coding and reimbursement questions to Rubenstein and Painter c/o Urology Times®, at urology_times@mmhgroup.com.

Questions of general interest will be chosen for publication. 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.