R36.9 — Urethral discharge, unspecified
ICD-10-CM
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Documentation Required
- There must be an attending/treating physician's order for each test documented in the patient's medical/clinical record prior to performing CPT 51798.
- The patient's medical record must include the assessment related to the visit complaint, relevant medical history, physical examination, results of pertinent tests/procedures, plan of treatment, and signed and dated office visit or operative report.
- Results documentation must show that the measurement was performed immediately post-void, include the date of the test, and identify the person who performed the test.
- For services requiring a referring/ordering physician, the name and NPI of the referring/ordering physician must be reported on the claim.
Key Coverage Criteria
- Measurement of post-void residual urine and/or bladder capacity by ultrasound (CPT 51798) is covered when ordered by the attending/treating/referring physician to evaluate a patient's urinary complaint and the medical record documents medical necessity (relevant history, physical exam, and supporting diagnostic results).
- Bladder ultrasound (bladder scan) is covered to measure post-void residual (PVR) urine volume to assess post-void urinary bladder retention.
- Bladder ultrasound for PVR is covered as part of diagnosis and ongoing management of lower urinary tract dysfunctions, including urinary incontinence and neurogenic bladder, when results will inform clinical management.
- Outpatient urine culture testing for bacteria is consideredmedically necessaryto evaluate any of the following situations:
- Clinical signs or symptoms suggesting urinary tract infection (UTI);or
- Abnormal urinalysis suggesting UTI;or
3 Active Policies
ANTHEM-CG-LAB-24 — CG-LAB-24 Outpatient Urine Culture
A57050 — Billing and Coding: Post-Void Residual Urine and/or Bladder Capacity by Ultrasound
L34085 — Post-Void Residual Urine and/or Bladder Capacity by Ultrasound
Related Codes
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