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Cost Savings and Reimbursement

Cost Savings for Acute Care

Prevent catheter-associated UTI with the BladderScan®, Realize Cost Savings

Urinary tract infections (UTIs) acquired in a hospital are a serious problem. They lengthen hospital stays and can create dangerous complications for acute care and post-operative patients. UTIs in extended care or skilled nursing facilities are an even greater problem, because patients in long-term care are more vulnerable to infection. In addition to the threat they pose to patient health, UTIs are extremely costly for hospitals and other healthcare facilities. Here are a few eye-opening facts about the cost of nosocomial (hospital-acquired) infections:

  • The average cost of one nosocomial UTI is estimated to be $1,875 per patient infection.
  • The cost of UTI nationwide ranges from $150 million to $1.8 billion every year.
  • 40 percent of all nosocomial infections occur in the urinary tract. Of these infections, 80 percent are caused by urinary tract catheterization and instrumentation.

Hospital-Acquired UTI can be Prevented

Minimizing catheterization is the key to reducing the rate of urinary tract infection. But, how can this be accomplished? Catheterization is often performed unnecessarily, because caregivers do not know how much urine is in a patient's bladder. BladderScan® use prevents unnecessary catheterization by enabling caregivers to measure patients' bladder volumes noninvasively so they can determine whether or not catheterization is truly necessary. Using the BladderScan®, you won't catheterize unless you need to. The BladderScan® reduces the cost of care because it:

  • Helps prevent unnecessary catheterization
  • Saves on staff time and the cost of catheter kits
  • Helps reduce the need for medication to treat infection caused by catheters
  • Helps reduces the risk of complications from catheter-associated UTI, which can include septicemia, bacteriuria, post-operative wound infection, and renal disease and may lead to premature death

The BladderScan® saves more than the money spent on UTI. It preserves patient dignity by reducing the need for an invasive and uncomfortable procedure. Patients are relieved to avoid catheterization, and nurses are equally relieved to avoid performing it. The BladderScan® improves the quality of life for both patients and caregivers.

BladderScan® Bladder Volume Instrument Cost Justification

Reimbursement for Private Practice

Reimbursement for BladderScan® Bladder Volume Instruments and FloPoint® Elite Uroflow Instruments is accomplished using the following CPT codes:

CPT 51741: Uroflowmetry, simple/complex measures the urine flow rate visually, electronically or with the use of a disposable unit. The flow rate reflects the combined activity of the detrusor muscle, bladder neck, and urethral function. Decreased flow rate may be due to poor detrusor function from, for example, neurologic lesions, obstructing BPH, or cystocele. Increased flow rate may indicate poor urethral function causing, for example, stress urinary incontinence (SUI) or intrinsic sphincter dysfunction (ISD).

CPT 51798: Measurement of post voiding residual urine and/or bladder capacity by ultrasound, non-imaging. Post-void 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

Final diagnosis coding remains the responsibility of the diagnosing physician.

ICD-9 Codes Supporting Medical Necessity of AortaScan®/BladderScan® Reimbursement Codes

Reimbursement for Extended Care

Summary of Reimbursement under Medicare Part B for the BladderScan® in Skilled Nursing Facilities
As of January 1, 2003, the HCPCS Level II code G0050 was replaced by the CPT code 51798. Although SNFs were previously reimbursed separately under G0050 for use of the BladderScan® BVI 3000 instrument for a Medicare Part B stay, there is no SNF reimbursement for CPT code 51798.

 

ICD-9 Codes Supporting Medical Necessity of AortaScan®/BladderScan® Reimbursement Codes

51798 - Measurement of post-voiding residual volume and/or bladder capacity by ultrasound, non-imaging
594 Calculus of lower urinary tract
594 Calculus in diverticulum of bladder
594.1 Other calculus in bladder
594.2 Calculus in urethra
594.8 Other lower urinary tract calculus
594.9 Calculus or lower urinary tract, unspecified
595 Cystitis
595 Acute cystitis
595.1 Chronic interstitial cystitis
595.2 Other chronic cystitis
595.3 Trigonitis
595.4 Cystitis in disease classified elsewhere
595.8 Other specified types of cystitis
595.81 Cystitis cystica
595.82 Irradiation cystitis
595.89 Other
595.9 Cystitis, unspecified
596 Other disorders of the bladder
596 Bladder neck obstruction
596.1 Intestinovesical fistula
596.2 Vesical fistula, not elsewhere classified
596.3 Diverticulum of bladder
596.4 Atony of bladder
596.5 Other functional disorders of bladder
596.51 Hypertonicity of bladder
596.52 Low bladder compliance
596.53 Paralysis of bladder
596.54 Neurogenic bladder NOS
596.55 Detrusor sphincter dyssynergia
596.59 Other functional disorders of bladder
596.6 Rupture of bladder, nontraumatic
596.7 Hemorrhage into bladder wall
596.8 Other specified disorders of bladder
596.9 Unspecified disorders of bladder
597 Urethritis, non sexually transmitted, and urethral syndrome
597 Urethral abscess
597.8 Other Urethritis
597.81 Urethral syndrome, NOS
598 Urethral stricture
598 Urethral stricture due to infection, unspecified
598.01 Due to infective disease classified elsewhere
598.1 Traumatic urethral stricture
598.2 Postoperative urethral stricture
598.8 Other specified causes of urethral stricture
598.9 Urethral stricture, unspecified
599 Other disorders of urethra and urinary tract
599 Urinary tract infection, site not specified
599.1 Urethral fistula
599.2 Urethral diverticulum
599.3 Urethral caruncle
599.4 Urethral false passage
599.5 Prolapse urethral mucosa
599.6 Urinary obstruction, unspecified
599.7 Hematuria
599.8 Other specified disorders of urethra and urinary tract
599.81 Urethral hypermobility
599.82 Intrinsic (urethral) sphincter deficiency ISD
599.83 Urethral instability
599.84 Other specified disorders of urethra
599.89 Other specified disorders of urinary tract
599.9 Unspecified disorders of urethra and urinary tract
788 Symptoms involving urinary system
788 Renal colic
788.1 Dysuria
788.2 Retention of urine
788.2 Retention of urine, unspecified
788.21 Incomplete bladder emptying
788.29 Other specified retention of urine
788.3 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
788.39 Other urinary incontinence
788.4 Frequency or urination and polyuria
788.41 Urinary frequency
788.42 Polyuria
788.43 Nocturia
788.5 Oliguria and anuria
788.6 Other abnormality of urination
788.61 Splitting of urinary stream
788.62 Slowing of urinary stream
788.69 Other abnormality of urinary stream
788.7 Urethral discharge
788.8 Extravasation of urine
788.9 Other symptoms involving urinary system
996 Complications peculiar to certain specified procedures
996.1 Mechanical complications of other vascular device, implant and graft
996.8 Complications of transplanted organ
996.8 Complications of transplanted organ, unspecified
996.81 Complications of transplanted kidney

ICD-9 Codes Supporting Medical Necessity of AortaScan®/BladderScan® Reimbursement Codes

51741 - Complex uroflowmetry (eg. calibrated electronic equipment)

344.61 Cauda equina syndrome with neurogenic bladder
596 Bladder neck obstruction
596.4 Atony of bladder
596.51 Hypertonicity of bladder
596.52 Low bladder compliance
596.53 Paralysis of bladder
596.54 Neurogenic bladder NOS
596.55 Detrusor sphincter dyssynergia
596.59 Other functional bladder disorder
598 Urethral stricture due to unspecified infection
598.1 Traumatic urethral stricture
598.2 Postoperative urethral stricture
598.8 Other specified causes of urethral stricture
598.9 Urethral stricture, unspecified
600 Hypertrophy of prostate (BPH)
788.2 Retention of urine, unspecified
788.21 Incomplete bladder emptying
788.29 Other specified retention of urine
788.3 Urinary incontinence, unspecified
788.31 Urge incontinence
788.32 Stress incontinence, male
788.33 Mixed incontinence
788.34 Incontinence w/o sensory awareness
788.34 Post-void dribbling
788.36 Nocturnal enuresis
788.37 Continuous leakage
788.39 Other urinary incontinence
788.41 Urinary frequency (micturition)
788.42 Polyuria
788.43 Nocturia
788.61 Splitting of urinary stream (intermittent)
788.62 Slowing of urinary stream (weak)
ICD-9 Codes Supporting Medical Necessity of AortaScan®/BladderScan® Reimbursement Codes


 76857 - Ultrasound, pelvic (nonobstetric), real time with image documentation; limited or follow-up

 ICD-9 codes supporting medical necessity of 76857 are wide ranging and vary from state to state. Please contact your billing service or state medical authority for appropriate codes in your practice area 


NB: There are 22 pages of possible ICD-9 codes supporting this reimbursement code that vary from state to state.

ICD-9 Codes Supporting Medical Necessity of AortaScan®/BladderScan® Reimbursement Codes 

AAA Screening covered by Private Insurers

Major private insurers may cover AAA screening as a preventative health benefit.
Patients and physicians should consult their private insurance provider to understand whether such services are provided for each patient.

Measurement of abdominal aortic diameter to help diagnose patient complaints

The AortaScan® AMI 9700 and BladderScan® BVI 9600 (in AortaScan® Mode) can be used as a diagnostic tool to help physicians identify the causes of symptoms that may indicate the presence of AAA. Such symptoms include, but are not limited to:
–         Chest, back or groin pain
–         Pulsating bulge or strong pulse in abdomen
–         Feeling of fullness after minimal food intake (early satiety)
–         Nausea/vomiting
ICD-9 Codes Supporting Medical Necessity of AortaScan®/BladderScan® Reimbursement Codes

AAA Screening covered by Medicare

Medicare offers a one-time only ultrasound screening for Abdominal Aortic Aneurysms (AAA), resulting from a referral from an Initial Preventive Physical Examination (IPPE)

Medicare Rules for AAA Screening Eligibility

  • Patient referred for ultrasound screening as a result of an initial preventive physical examination (IPPE – “Welcome to Medicare” Exam)
  • Patient has not been previously furnished a covered AAA screening ultrasound examination under the Medicare program;
  • Patient is included in one of the following risk categories:
    • Men and women with a family history of an AAA; or
    • Men age 65 to 75 years who have smoked at least 100 cigarettes

Medicare Reimbursement for AAA Screening

For more information about Medicare’s coverage criteria and billing procedures for the AAA and IPPE benefits, refer to the following MLN Matters articles:

AAA Screening covered by Private Insurers
Major private insurers may cover AAA screening as a preventative health benefit.
Patients and physicians should consult their private insurance provider to understand whether such services are provided for each patient.