Urology Coding Alert

Question: I am confused about which diagnosis codes Medicare considers covered for bladder scans measuring post-void residual urine, G0050. Is there a list of the ICD-9 codes somewhere that I can use as a reference? Alabama Subscriber Answer: Don't just scan your carrier's list of diagnosis codes when you are submitting a claim for G0050 or you could find that your "foolproof" ICD-9 codes for bladder scans weren't foolproof after all. The first thing you have to remember about diagnosis coding for a bladder scan, in this case G0050 (Measurement of post-voiding residual urine and/or bladder capacity by ultrasound) for a Medicare patient, is that deciding which ICD-9 codes are reimbursable is under the carriers'discretion. For example, Empire Medicare services for New Jersey lists the following diagnosis codes as covered: 595.9 Cystitis, unspecified 596.3 Diverticulum of bladder 596.4 Atony of bladder 596.54 Neurogenic bladder NOS 599.0 Urinary tract infection, site not specified 599.7 Hematuria 600.0 Hypertrophy (benign) of prostate 600.2 Benign localized hyperplasia of prostate 625.6 Stress incontinence, female 788.20 Retention of urine, unspecified 788.21 Incomplete bladder emptying 788.29 Other specified retention of urine 788.30 Urinary incontinence, unspecified 788.31 Urge incontinence 788.32 Stress incontinence, male 788.33 Mixed incontinence, (male) (female) 788.34 Incontinence without sensory awareness 788.35 Post-void dribbling 788.36 Nocturnal enuresis 788.37 Continuous leakage 788.39 Other urinary incontinence 788.41 Urinary frequency 788.42 Polyuria 788.43 Nocturia 788.5 Oliguria and anuria 788.61 Splitting of urinary stream 788.62 Slowing of urinary stream 788.69 Other 788.9 Other symptoms involving urinary system. Whenever you do a diagnostic test, the diagnosis code linked to the test should be the findings of the test unless the results of the test are negative, in which case the signs or symptoms that prompted the exam should be reported as the ICD-9 code(s).

For example, a 70-year-old female patient presents with persistent urinary incontinence, and the urologist orders a bladder scan. The results of the bladder scan are negative and there is no residual urine, so the diagnosis code that should be linked to the bladder scan, G0050, is 788.33 (Mixed incontinence, [male] [female]). But if the results of the bladder scan positively identify an incontinence disorder, report the results as the primary diagnosis code. You should also be careful when you report a "result" of the bladder scan as the diagnosis code. For example, if your urologist orders a bladder scan for a patient and the bladder scan reveals a urethral stricture, not otherwise specified (NOS), 598.9, you won't be reimbursed for G0050 because the diagnosis code does not support the procedure. Instead, you will need to report the signs or symptoms that make up the reason for the bladder scan. Definitely include any additional observations from the bladder [...]