Highlight On Three Codes

Current Procedural Terminology (CPT) 51798

As stated in the AMA Professional Edition of Current Procedural Terminology Manual, CPT code 51798 describes measurement of post voiding residual urine (PVR), and/or bladder capacity by ultrasound, non-imaging.

Urodynamics

CPT 51798 comes under the section of Urodynamics. 
What is urodynamics? 
Urodynamics is a group of tests performed on a patient’s lower urinary tract when a patient is experiencing such conditions as frequent urination, urgency of urination, weak stream, intermittent stream, frequent urinary tract infection, incomplete bladder emptying, and/or urinary incontinence.

In the CPT manual, under the section of Urodynamics, the section guidelines state that:

• ·         The tests in this section may be used separately or in combination with each other
• ·         When multiple tests are performed at the same session, modifier 51 should be appended
• ·         All the tests are performed by, or are under the direct supervision of a physician or other qualified health care professional
• ·         All the instruments, equipment, supplies, technical assistance, and other sterile supplies are bundled into the CPT code
• ·         If the physician performs the professional service only, (interpretation of the tests), modifier 26 (professional component) is appended to the CPT codes for the tests if Professional fees are applicable to the CPT code.

Coder’s Desk Reference-51798

After the patient has voided, the ultrasound measures the residual urine and/or bladder capacity. The ultrasound machine used for this procedure is an ultrasound scanner. The scanning head is directed over the suprapubic area while the patient is lying down in the supine position. The calculation of the residual urine is performed by the software in the scanner and provides immediate results.

Some specifics to CPT 51798--

• ·         There are no Professional fees associated with CPT code 51798.
• ·         If an interpretation is performed, the results can be included in an Evaluation and Management service.
• ·         When reporting an Evaluation and Management CPT code with CPT code 51798, modifier 25 may need to be appended to the Evaluation and Management CPT code.
• ·         It is in the “scope of duty” of most Ancillary providers (e.g. registered nurse, medical assistant) to perform a PVR.

Current Procedural Terminology (CPT) Category II

2000F

On one my pages on this Blog site, entitled “Current Medical Coding Classification Systems”-I explained that Category II codes were “performance measurement codes.” Category II codes are used to track the performance of certain tests and or test results. Category II CPT® codes are used for information purposes only, their usage is optional, and no payment is associated with these codes. 

CPT II codes consist of five alphanumeric characters in a string, ending with the letter “F.”

• 1.    Category II codes describe clinical components that may be included in evaluation and management services or clinical services and this is why there is no relative value associated with them.
• 2.    As stated in the AMA Professional Edition of Current Procedural Terminology Manual, code 2000F, located under Physical Exam, describes “blood pressure measured.
• 
  
• If No Money, Why Use?

• ·         Improve performance in healthcare organizations
• ·         Medicare may pay an incentive to report Category II codes
• ·         Identify opportunities for improvement in healthcare organizations

How to Bill Category II Codes

Category II codes are billed in the same code field as CPT category I codes.

Current Procedural Terminology (CPT) Category III

 0355T

Also known as a “local” code or “temporary,” this code is used to designate an emerging technology and to track the usage of the code. Visit my page on this blog entitled “Current Medical Coding Classification Systems” to read more.

1.    Category III CPT® codes must be used in place of an unlisted procedure code. The reimbursement for these codes is determined by the carrier. By using a Category III code instead of a Category I unlisted code, data will be collected on the Category III code to show how often the emerging technology is used.

2.    As stated in the AMA Professional Edition of Current Procedural Terminology Manual, code 0355T describes “extra-osseous subtalar joint implant for talotarsal stabilization.”

3.    Code 0335T will “sunset” January 2019

What Is The Life Span Of A Category III Code?

·         Not all Category III codes will become a Category I code.

·         If a Category III code does not become a Category I code within five years, the code will “sunset” unless it is determined that the code needs to continue as a temporary Category III code.