LCD/NCD Portal

L29261

 

POST-VOIDING RESIDUAL ULTRASOUND

 

02/02/2009

 

Indications and Limitations of Coverage and/or Medical Necessity

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

o To assess urinary retention

o To assess incomplete bladder emptying

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

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

o 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.

 

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 URINARY OBSTRUCTION, UNSPECIFIED

599.69 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 RENAL COLIC

788.1 DYSURIA

788.20 RETENTION OF URINE UNSPECIFIED

788.21 INCOMPLETE BLADDER EMPTYING

788.29 OTHER SPECIFIED RETENTION OF URINE

788.30 URINARY INCONTINENCE UNSPECIFIED

788.31 URGE INCONTINENCE

788.32 STRESS INCONTINENCE MALE

788.33 MIXED INCONTINENCE (MALE) (FEMALE)

788.34 INCONTINENCE WITHOUT SENSORY AWARENESS

788.35 POST-VOID DRIBBLING

788.36 NOCTURNAL ENURESIS

788.37 CONTINUOUS LEAKAGE

788.38 OVERFLOW INCONTINENCE

788.39 OTHER URINARY INCONTINENCE

788.41 URINARY FREQUENCY

788.42 POLYURIA

788.43 NOCTURIA

788.5 OLIGURIA AND ANURIA

788.61 SPLITTING OF URINARY STREAM

788.62 SLOWING OF URINARY STREAM

788.63 URGENCY OF URINATION

788.64 URINARY HESITANCY

788.65 STRAINING ON URINATION

788.69 OTHER ABNORMALITY OF URINARY STREAM

788.7 URETHRAL DISCHARGE

788.8 EXTRAVASATION OF URINE

788.91 FUNCTIONAL URINARY INCONTINENCE

788.99 OTHER SYMPTOMS INVOLVING URINARY SYSTEM

 

 

Documentation 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.

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.

Treatment Logic

• 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.

 

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.

 

02/02/2009

The official local coverage determination (LCD) is the version on the Medicare coverage database at www.cms.gov/medicare-coverage-database/.

 

AMA CPT / ADA CDT Copyright Statement

CPT codes, descriptions and other data only are copyright 2012 American Medical Association (or such other date of publication of CPT). All Rights Reserved. Applicable FARS/DFARS Clauses Apply. Current Dental Terminology, (CDT) (including procedure codes, nomenclature, descriptors and other data contained therein) is copyright by the American Dental Association. © 2002, 2004 American Dental Association. All rights reserved. Applicable FARS/DFARS apply.

 

CMS LCD POST-VOIDING RESIDUAL ULTRASOUND