CMS Post-Void Residual Urine and/or Bladder Capacity by Ultrasound Form

Summary Of Evidence

N/A

Analysis of Evidence

N/A

Abstract:

Post-void residual (PVR) urine volume is the volume of urine 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.

Bladder ultrasound or bladder scan to determine post-void residual urine employs either a standard ultrasound machine or a portable, battery-powered ultrasound device which consists of a hand-held ultrasound transducer (scanhead) and a base unit with a display screen. This unit automatically calculates and displays the bladder volume. This LCD defines Medicare coverage for the test.

Indications:

Bladder scan ultrasonography is utilized to assess post-void urinary bladder retention. It can be an important component in the diagnosis and ongoing management of lower urinary tract dysfunctions, including, but not limited to, urinary incontinence and/or neurogenic bladder.

When ultrasound measurement for post-void residual is the only service clinically indicated and/or rendered, it is inappropriate to report a pelvic ultrasound code (76856 or 76857) instead of, or in addition to, this service. Likewise, if a pelvic ultrasound code is appropriately billed, it is inappropriate to bill separately for the PVR measurement since payment for this has already been included in the payment of the pelvic study.

Limitations:

Routine ultrasound examination of incontinent patients in nursing homes and skilled nursing facilities is not warranted. PVR determination is only one component of incontinence evaluation. The patient must be capable of participating in the complete evaluation process and in the treatment plan in order for this testing to be appropriate. The use of ultrasound to measure PVR is not medically necessary if no treatment is planned, regardless of the findings.

The use of both ultrasound and catheterization during the same session to determine PVR is not medically necessary.

Other Comments:

For claims submitted to the Part A MAC: this coverage determination also applies within states outside the primary geographic jurisdiction with facilities that have nominated CGS Administrators to process their claims.

Bill type codes only apply to providers who bill these services to the Part A MAC. Bill type codes do not apply to physicians, other professionals and suppliers who bill these services to the carrier or Part B MAC.

Limitation of liability and refund requirements apply when denials are likely, whether based on medical necessity or other coverage reasons. The provider/supplier must notify the beneficiary in writing, prior to rendering the service, if the provider/supplier is aware that the test, item or procedure may not be covered by Medicare. The limitation of liability and refund requirements do not apply when the test, item or procedure is statutorily excluded, has no Medicare benefit category or is rendered for screening purposes.

For dates of service on or after April 1, 2010, bill type 77X should be used to report FQHC services.