“If one performs a bladder catheterization to obtain the post-void residual, use CPT code 51701,” write Jonathan Rubenstein, MD, and Mark Painter.
I read your post titled, “What are the documentation requirements for code 51798?”1 It was very helpful. I would also like to know which Common Procedural Terminology (CPT) code we would use for a post-void residual done without ultrasound.
To best answer your question, we would need to know a bit more specifically what is meant by “without ultrasound.” Do you mean by catheter, or do you mean a hand-held device that detects the bladder volume? CPT code 51798’s description reads, “Measurement of post-voiding residual urine and/or bladder capacity by ultrasound, non-imaging.” Therefore, whether the bladder is actually imaged, and the volume calculated or a non-imaging device is used to give a bladder volume, the code can be used. If one performs a bladder catheterization to obtain the post-void residual, use CPT code 51701 (Insertion of non-indwelling bladder catheter [eg, straight catheterization for residual urine]).
Can CPT 52601 be coded more than once per patient?
CPT code 52601 (Transurethral electrosurgical resection of prostate, including control of postoperative bleeding, complete [vasectomy, meatotomy, cystourethroscopy, urethral calibration and/or dilation, and internal urethrotomy are included])still has a “once in a lifetime” restriction. If a subsequent transurethral resection of the prostate is performed, use CPT code 52630 (Transurethral resection; residual or regrowth of obstructive prostate tissue including control of postoperative bleeding, complete [vasectomy, meatotomy, cystourethroscopy, urethral calibration and/or dilation, and internal urethrotomy are included]).