Wiki 51798 twice in one day?

[Bernadette10]

Can 51798 be billed twice in one day?
Example: The patient comes in for a voiding trial, has the bladder irrigated with 200 mL of sterile water through the Foley cath. Then has the cath removed and voids, and a PVR is measured with ultrasound showing 100 mL.
Then comes back at 2:00 in the afternoon and has another PVR measured with ultrasound showing 5 mL.

Can 51798 and 51798-XE be billed if it's non-Medicare, since there were 2 separate PVRs were done? The MUE for Medicare is 1, but a private payor might pay?

 

[sls314]

Most private payers use the CMS MUE edits as well. However, keep in mind that CPT 51798 has an MAI indicator 3.

That means that even Medicare could pay for units in excess of the MUE if the documentation supports it.

Refer to this MLN Matters document to see how to submit documentation for units in excess of the MUE. For CPT 51798, look specifically under the section about MUEs for codes with an MAI of 3.

https://www.cms.gov/files/document/revised-modification-medically-unlikely-edit-mue-program-mm8853.pdf

 

[Bernadette10]

Thank you!