AMA CPT / ADA CDT Copyright StatementCPT codes, descriptions and other data only are copyright 2004 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 National Coverage Policy
Indications and Limitations of Coverage and/or Medical NecessityUrinary tract imaging is not recommended in the routine evaluation of men with prostatism unless they have one or more of the following medically necessary indications: hematuria, urinary tract infection, renal insufficiency, history of urolithiasis, history of urinary tract surgery or surgery is planned. A diagnosis of benign prostatic hypertrophy (BPH) does not indicate the medical necessity of an ultrasound for determination of bladder residual volume. The patient must have other factors which indicate the need for testing. A routine ultrasound for the purpose of determining residual volume is not a covered service when performed in the place of a routine catheterization. Routine catheterizations are not separately billable. This is included in the office visit. If the patient has medical indication for a complete study, CPT code 76856 should be reported. However the ICD-9 diagnosis code must indicate the medical necessity and the patients medical record must contain adequate documentation. Medically necessary measurement of post-voiding residual urine and/or bladder capacity by ultrasound without imaging may be billed with CPT code 51798. Coverage Topic: Diagnostic Tests and X-Rays Coding InformationBill Type Codes999x Not Applicable Revenue Codes99999 Not Applicable CPT/HCPCS Codes
ICD-9 Codes that Support Medical NecessityIf a pelvic ultrasound is performed in relation to an illness, injury or specific symptomatology, the diagnosis code must reflect the medical necessity for the procedure.
THIS SECTION OF ICD-9 TABLE TRUNCATED FOR THE SAMPLE POLICY ON THE WEBSITE ONLY. THE ACTUAL POLICIES CONTAIN THE ENTIRE ICD-9 TABLE
Diagnoses that Support Medical Necessity ICD-9 Codes that DO NOT Support Medical Necessity ICD-9 Codes that DO NOT Support Medical Necessity Asterisk Explanation Diagnoses that DO NOT Support Medical Necessity General InformationDocumentation RequirementsMedical documentation for all Medicare covered pelvic ultrasounds is expected to clearly and concisely indicate the medical necessity for the procedure within the patient's medical record, should chart review become necessary. For the evaluation of men with prostatism with pelvic echography, entries in the medical record must reflect that the examination was not done for routine purposes and that one of the conditions outlined in the "Indications and Limitations of Coverage and/or Medical Necessity" was present: hematuria, urinary tract infection, renal insufficiency, history of urolithiasis, history of urinary tract surgery or surgery is planned. Appendices; N/A Advisory Committee Meeting NotesThis policy does not reflect the sole opinion of the contractor or contractor medical director. Although the final decision rests with the contractor, this policy was developed in cooperation with advisory groups, which includes representatives from various specialties within the medical community. Start Date of Comment
Period : 2/16/2005 Last Reviewed On: N/A
|
||||||||||||||||||||||||||||||||||||