R34 — Anuria and oliguria
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- Medical records must document that the ultrasound was limited to retroperitoneal structures when billing CPT 76770/76775/76776, including images/findings demonstrating limitation to the retroperitoneum.
- If the exam was expanded to include organs outside the retroperitoneum, documentation must reflect the expansion and support billing a full or limited abdominal ultrasound (CPT 76700/76705/76706).
- Claims and documentation should follow the complementary Local Coverage Determination L34577 and any applicable LCD requirements.
- The patient medical record must document the ordering provider's assessment related to the visit complaint, relevant medical history, physical examination, and results of pertinent diagnostic tests or procedures that support medical necessity.
Key Coverage Criteria
- Retroperitoneal ultrasound (CPT 76770, 76775, 76776) is covered when the exam is limited solely to retroperitoneal structures.
- A full (complete) or limited abdominal ultrasound (CPT 76700, 76705, 76706) is covered when the exam includes organs or structures outside the retroperitoneum or when primary findings involve non-retroperitoneal structures (e.g., gallbladder, liver, spleen, common bile duct).
- Cystometrogram (CPT 51725, 51726) is covered when performed to evaluate detrusor contractions, abnormalities of bladder compliance, measure post-void residual, determine bladder capacity, or detect detrusor sphincter dyssynergia (DSD).
- Uroflowmetry (CPT 51736, 51741) is covered when used to measure urine flow rate to evaluate suspected reduced detrusor function (eg, neurologic lesion), obstructive causes (eg, BPH, cystocele), or increased flow suggesting stress urinary incontinence (SUI) or intrinsic sphincter dysfunction (ISD).
- Urethral pressure profile studies (CPT 51727) are covered when other noninvasive tests are inconclusive and the study is needed to rule out severe urethral incompetence or for limited applications such as artificial urinary sphincter evaluation.
- Stimulus evoked response testing (CPT 51792) is covered when used to evaluate suspected cauda equina syndrome or other indications where this neurophysiologic test is clinically indicated.
10 Active Policies
A57455 — Billing and Coding: Urodynamics
J06
L33576 — Urodynamics
J06
A55336 — Billing and Coding: Retroperitoneal Ultrasound
A56802 — Billing and Coding: Urodynamics
A57050 — Billing and Coding: Post-Void Residual Urine and/or Bladder Capacity by Ultrasound
Related Codes
Have a follow-up question?
Ask Verity about documentation requirements, denial risks, or coverage in your state.