CPT 51798 will not be paid if performed in place of service 21 or 23, according to Jonathan Rubenstein, and Mark Painter.
I need some guidance on billing for the bladder scan procedure (51798). As it is a technical-only code, can this be billed in place of service (POS) 21 when a patient is inpatient or in ED POS 23 when performed outside of a uroflow procedure? Also, can it be billed in POS 22 as part of the uroflow procedure with 51741 and 51784? Typically, I have billed this with POS 11, but I need some guidance on whether it is billable to ED, inpatient, or outpatient hospital.
First, you are correct that current procedural terminology (CPT) code 51798, measurement of postvoid residual (PVR), is a technical-only code and therefore has no work value. Unfortunately, if you look into Medicare’s resource-based relative value scale (RBRVS), the actual value assigned to the Nonfacility Practice Expense Value is NA (not applicable), meaning the code will not be paid if performed in a place of service 21 or 23. The service is considered paid for in the facility payment provided to your hospital.
As for the second part of your question about POS 22 (on campus-outpatient hospital), this is also a facility place of service and therefore the 51798 will not be paid. As you indicated, it is appropriate to report 51741 and 51784 for any place of service listed above (21, 22, or 23), with modifier -26. You will be paid the facility rate for the services. Typically, the facility rate does not change the work Relative Value Units associated with the procedure, but often pays slightly less due to a lower practice expense value.
Remember, using data in each case to provide treatment may allow you to include the data provided from 51798 as part of the data section for Medical Decision Making, which can affect the level of service selected for evaluation and management (E/M) services provided to the patient on that date or another date. Documentation of the visit must include the value (PVR in mL) from the service and support the data’s use in the patient’s treatment or in the diagnosis. Although this is not a substitute for payment received in the office setting, it is the appropriate use of the data based on the code and value.
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.