Wiki 51798 vs 76775

[svanhorn73]

Ok everyone, please weigh in on this one. I have been billing Medicare for Urology for 4 yrs. Have any of you ever heard that you cannot bill a PVR with an E/M if the doctor only puts on DX code on the superbill.

Now this is what I know, if you bill 76775 to Medicare you need to have proper documentation in the patient chart,. 2. The patient must have one of the dx code on the LCD list in order to get the claim paid.

As for the 51798 (Post Void Residual) Medicare will pay no matter what the diagnosis is.

if I am wrong please advise me on the correct information.

Thanks for your help.

 

[Kelly_Mayumi]

I believe you have to have a urinary symptom (788.__) attached to 51798. Also 51798 has an XXX global period so there should be no reason you couldn't bill this with an E/M? Obvisouly you would need med nec and documentation that is was preformed and the results.

 

[cynsim1217]

You definitely need a 25 modifier with the visit, but it DOES matter what code you bill. It will not get paid with a Prostate CA code or BPH. It will get paid using urinary symptoms such as frequency, nocturia, retention, etc.