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If the physician is billing the 76770 wouldn't he then only bill the 51798 with a modifier or just bill the 76857 and the 76770? I can't seem to find the guidelines on billing these 3 codes. Any help or suggestions would be greatly appreciated.
76770 refers to a complete retroperitoneal ultrasound. The images and report should contain measurements and imterpretation of ALL of the anatomic structures in the retroperitoneum (kidneys, abdominal aorta, common iliac artery origins, inferior vena cava, kidneys urinary bladder and any retroperitoneal abnormality). If this is performed and documented then 76857 should not be billed separately since the pelvic organs are included in a complete retroperitoneal ultrasound. If the images and report are only for the purposes of evaluating one, or some, organ(s) in the retroperitoneum, then you should bill 76775 for a limited retroperitoneal ultrasound instead.
76857 is a limited pelvic ultrasound. Again this is used to bill for images and report/interpretation of the pelvic organs. This is appropriate to bill if the intent and documentation of the test is to evaluate one or some of the organs in the pelvis for abnormalities. If all of the pelvic organs (uterus and adnexal structures, endometrium, bladder, and of any abnormal pelvic pathology) are evaluated and imaged, then you can bill a complete pelvic ultrasound with code 76856.
51798 is used when the intent of the test and the documentation are strictly to evaluate the amount of urine remaining in the bladder after the patient has urinated. It may be performed with the same ultrasound machine (or a bladder scanner) and the bladder may be imaged, but if the intent and purpose of the test is strictly to evaluate post-void residual then this is the only code that should be billed.
Here's a link to the American Urologic Assocation's website where they explain much of the same along with a lot more information on proper coding for urologic ultrasounds.
