Complete male pelvic ultrasound

[Liz2013]

Recently, Aetna have been requesting notes when we bill CPT 76856 and they have been downcoding this code to CPT 76857. As example we have the following documentation:

Bladder: the bladder has no residual. Bladdere volume measure - 0cc. Post void bladder volume was performed. PVR measured 0cc

Distal ureters: The distal ureters were not visualized. Ureteral jets were not assessed.

Prostate: The prostate is in normal anatomic position. The prostate measures a calculated volume of 48 grams. The prostate has calcifications

Seminal Vesicles: The seminal vesicles are normal
Impression(s): Prostate enlargement and prostate calcification

Do you think this should be a limited or complete study? Please provide me with your input. I will appreciate it.
Thank you,

 

[lorrieb23]

76857 on male patient

I have recently come across the question as to whether or not a male patient could be billed for 76857 by our ultra sound tech. The physician ordered 76857 to get a view of the bladder but the tech interpreted the order as a 51798. This of course was denied for medical necessity because there wasn't a urological diagnosis for the test. Of course 76857 can be performed on a male patient. Not really sure why your payer is downcoding though. Just thought I would add to the conversation.