L29261-LCD

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Local Coverage Determination (LCD) for Post-Voiding Residual Ultrasound (L29261)

Contractor Information

Contractor Name

First Coast Service Options, Inc. opens in new window

Contractor Number 09102

Contractor Type MAC - Part B

LCD Information

Document Information

LCD ID Number L29261

LCD Title

Post-Voiding Residual Ultrasound

Contractor's Determination Number 51798

Primary Geographic Jurisdiction opens in new window

Florida

Oversight Region Region IV

AMA CPT/ADA CDT Copyright Statement

CPT only copyright 2002-2011 American Medical Association. All Rights Reserved. CPT is a registered trademark of the American Medical Association. Applicable FARS/DFARS Apply to Government Use. Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein. The Code on Dental Procedures and Nomenclature (Code) is published in Current Dental Terminology (CDT). Copyright © American Dental Association. All rights reserved. CDT and CDT-2010 are trademarks of the American Dental Association.

Original Determination Effective Date

For services performed on or after 02/02/2009

Original Determination Ending Date

Revision Effective Date

Revision Ending Date

CMS National Coverage Policy

Language quoted from CMS National Coverage Determinations (NCDs) and coverage provisions in interpretive manuals are italicized throughout the Local Coverage Determination (LCD). NCDs and coverage provisions in interpretive manuals are not subject to the LCD Review Process (42 CFR 405.860[b] and 42 CFR 426 [Subpart D]). In addition, an administrative law judge may not review an NCD. See §1869(f)(1)(A)(i) of the Social Security Act.

Unless otherwise specified, italicized text represents quotation from one or more of the following CMS sources: CMS Manual System, Pub. 100-03, Medicare National Coverage, Chapter 1, Part 4, Section 220.5

Indications and Limitations of Coverage and/or Medical Necessity

Post-voiding residual (PVR) urine volume is the volume in the bladder immediately after the completion of voiding. The standard method of determining PVR urine volumes is intermittent catheterization, which is associated with increased risk of urinary infection, urethral trauma and discomfort for the patient. Bladder ultrasound has been introduced as an alternative, noninvasive method, to avoid the potential complications of intermittent catheterization.

The use of ultrasound to determine PVR is considered medically necessary and reimbursable for the following indications:

• To assess urinary retention

• To assess incomplete bladder emptying

• To assist with bladder re-training by determining the need to void based on bladder volume

• To determine actual bladder volume in patients who have incomplete bladder emptying and require frequent catheterizations to drain the bladder

PVR ultrasound is not considered to be medically necessary when performed for routine screening purposes or when no treatment is planned regardless of the finding.

Coding Information

Bill Type Codes:

Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the policy does not apply to that Bill Type. Complete absence of all Bill Types indicates that coverage is not influenced by Bill Type and the policy should be assumed to apply equally to all claims.

Revenue Codes:

Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory; unless specified in the policy services reported under other Revenue Codes are equally subject to this coverage determination. Complete absence of all Revenue Codes indicates that coverage is not influenced by Revenue Code and the policy should be assumed to apply equally to all Revenue Codes.

99999 Not Applicable

CPT/HCPCS Codes

51798 MEASUREMENT OF POST-VOIDING RESIDUAL URINE AND/OR BLADDER CAPACITY BY ULTRASOUND, NON

-IMAGING

ICD-9 Codes that Support Medical Necessity

344.61 CAUDA EQUINA SYNDROME WITH NEUROGENIC BLADDER

596.4 ATONY OF BLADDER

596.54 NEUROGENIC BLADDER NOS

596.59 OTHER FUNCTIONAL DISORDER OF BLADDER

599.60 - 599.69 opens in new window

URINARY OBSTRUCTION, UNSPECIFIED - URINARY OBSTRUCTION, NOT ELSEWHERE CLASSIFIED

600.01 HYPERTROPHY (BENIGN) OF PROSTATE WITH URINARY OBSTRUCTION AND OTHER LOWER URINARY TRACT SYMPTOMS (LUTS)

625.6 STRESS INCONTINENCE FEMALE

788.0 - 788.99 opens in new

window RENAL COLIC - OTHER SYMPTOMS INVOLVING URINARY SYSTEM

Diagnoses that Support Medical Necessity N/A

ICD-9 Codes that DO NOT Support Medical Necessity XX000 Not Applicable

ICD-9 Codes that DO NOT Support Medical Necessity Asterisk Explanation

Diagnoses that DO NOT Support Medical Necessity N/A

General Information

Documentations Requirements

Medical records should support the ICD-9-CM code billed for the services rendered. Medical record documentation justifying the need for and/or frequency of this service at the time that the service was rendered must be made available to the Carrier upon request.

Appendices

Utilization Guidelines It is not expected that a post-voiding residual ultrasound will be performed greater than three (3) times per day. Medical documentation should justify services performed at a greater frequency.

Sources of Information and Basis for Decision

Diagnostic Ultrasound Corporation (2003) Program of Excellence. http://excellence.dxu.com This source was used to gain knowledge about the use of ultrasound when determining post void residual. (Retrieved from Internet March 18, 2004)

Lepor, H. & Chancellor, M. (2004) Differential diagnosis and treatment of impaired bladder emptying. Reviews in Urology 2004; 6 (suppl1): S24-S31 This source was used to identify diagnosis which may require determination of post void residual as part of treatment regimen.

Lepor, H. (2004) Challenges in the detection and diagnosis of bladder dysfunction: optimal strategies for the primary care physician. Reviews in Urology 2004; 6 (suppl 1): S1-S2 This source was used in identifying medical conditions which would benefit from the determination of post void residual.

Newman, D.K.(2004) Using the BladderScanTM for bladder volume assessment. http://www.seekwellness.com/incontinence/using_the_bladderscan.htm This source was used to assist in identifying implications and limitations for use of a bladder scan when determining volume assessment.

Advisory Committee Meeting Notes This Local Coverage Determination (LCD) does not reflect the sole opinion of the contractor or Contractor Medical Director. Although the final decision rests with the contractor, this LCD was

developed in cooperation with advisory groups, which includes representatives from numerous societies.

Start Date of Comment Period

End Date of Comment Period

Start Date of Notice Period 12/04/2008

Revision History Number Original

Revision History Explanation Revision Number:Original Start Date of Comment Period:N/A

Start Date of Notice Period:12/04/2008

Revised Effective Date:02/02/2009

LCR B2009-

December 2008 Bulletin

This LCD consolidates and replaces all previous policies and publications on this subject by the carrier predecessors of First Coast Service Options, Inc. (Triple S and FCSO).

For Florida (00590) this LCD (L29261) replaces LCD L19592 as the policy in notice. This document (L29261) is effective on 02/02/2009.

Reason for Change