CPT® Code 51797
Add-On Code

Official Description

Voiding pressure studies, intra-abdominal (ie, rectal, gastric, intraperitoneal) (List separately in addition to code for primary procedure)

Common Language Description

Voiding pressure studies, specifically intra-abdominal measurements, are diagnostic procedures that assess the pressure exerted within the abdominal cavity during the act of voiding. This procedure is essential for understanding how much effort a patient must exert to successfully empty their bladder. During the study, a catheter is inserted into the rectum to facilitate the measurement of intra-abdominal pressure. A specialized device is utilized to accurately record this pressure while the bladder is filled with fluid. As the patient attempts to void, the intra-abdominal pressure is monitored and documented. It is important to note that multiple bladder fills may be required to ensure a comprehensive evaluation of the intra-abdominal pressure. The physician interprets the data collected, specifically the intra-abdominal voiding pressure, and compares it to the total bladder (intravesical) voiding pressure. This comparison is crucial for determining the true intravesical pressure during the voiding process. The intra-abdominal voiding pressure can be assessed in various locations, including the rectal, gastric, and intraperitoneal areas, and is reported separately in conjunction with a primary bladder voiding pressure study.

1. Indications

The indications for performing intra-abdominal voiding pressure studies include the following:

Assessment of Voiding Dysfunction This procedure is indicated for patients experiencing difficulties with voiding, which may include symptoms such as urinary retention or incomplete bladder emptying.
Evaluation of Intra-Abdominal Pressure It is performed to measure the intra-abdominal pressure during voiding, which can help in diagnosing conditions related to abnormal bladder function.
Preoperative Assessment This study may be indicated prior to surgical interventions to provide a baseline understanding of the patient's voiding pressures.

2. Procedure

The procedure for conducting intra-abdominal voiding pressure studies involves several key steps:

Step 1: Patient Preparation The patient is prepared for the procedure, which may include explaining the process and obtaining informed consent. The patient may be positioned comfortably to facilitate the insertion of the catheter.
Step 2: Catheter Insertion A catheter is carefully inserted into the rectum. This catheter is essential for measuring the intra-abdominal pressure during the voiding process.
Step 3: Bladder Filling The bladder is filled with a sterile fluid to a predetermined volume. This step is crucial as it simulates the conditions under which the voiding pressure will be measured.
Step 4: Measurement of Intra-Abdominal Pressure As the patient attempts to void, the intra-abdominal pressure is recorded using a specialized device. This measurement is taken simultaneously with the bladder filling to ensure accuracy.
Step 5: Data Interpretation After the voiding attempt, the physician interprets the recorded intra-abdominal voiding pressure and compares it to the total bladder (intravesical) voiding pressure. This comparison is vital for determining the true intravesical pressure during voiding.

3. Post-Procedure

Post-procedure care for patients undergoing intra-abdominal voiding pressure studies typically involves monitoring for any immediate complications or discomfort. Patients may be advised to hydrate adequately and report any unusual symptoms, such as pain or difficulty voiding, following the procedure. The physician will review the results of the study with the patient during a follow-up appointment, discussing any necessary further evaluations or treatment options based on the findings.

Short Descr	INTRAABDOMINAL PRESSURE TEST
Medium Descr	VOID PRESSURE STUDIES INTRAABDOMINAL
Long Descr	Voiding pressure studies, intra-abdominal (ie, rectal, gastric, intraperitoneal) (List separately in addition to code for primary procedure)
Status Code	Active Code
Global Days	ZZZ - Code Related to Another Service
PC/TC Indicator (26, TC)	1 - Diagnostic Tests for Radiology Services
Multiple Procedures (51)	0 - No payment adjustment rules for multiple procedures apply.
Bilateral Surgery (50)	0 - 150% payment adjustment for bilateral procedures does NOT apply.
Physician Supervisions	09 - Concept does not apply.
Assistant Surgeon (80, 82)	0 - Payment restriction for assistants at surgery applies to this procedure...
Co-Surgeons (62)	0 - Co-surgeons not permitted for this procedure.
Team Surgery (66)	0 - Team surgeons not permitted for this procedure.
Diagnostic Imaging Family	99 - Concept Does Not Apply
APC Status Indicator	Items and Services Packaged into APC Rates
ASC Payment Indicator	Packaged service/item; no separate payment made.
Type of Service (TOS)	2 - Surgery
Berenson-Eggers TOS (BETOS)	P6C - Minor procedures - other (Medicare fee schedule)
MUE	1
CCS Clinical Classification	200 - Nonoperative urinary system measurements

This is an add-on code that must be used in conjunction with one of these primary codes.

51728	MPFS Status: Active Code APC J1 ASC P3 CPT Assistant Article Illustration for Code Complex cystometrogram (ie, calibrated electronic equipment); with voiding pressure studies (ie, bladder voiding pressure), any technique
51729	MPFS Status: Active Code APC J1 ASC P3 CPT Assistant Article Illustration for Code Complex cystometrogram (ie, calibrated electronic equipment); with voiding pressure studies (ie, bladder voiding pressure) and urethral pressure profile studies (ie, urethral closure pressure profile), any technique

26	Professional component: certain procedures are a combination of a physician or other qualified health care professional component and a technical component. when the physician or other qualified health care professional component is reported separately, the service may be identified by adding modifier 26 to the usual procedure number.
TC	Technical component; under certain circumstances, a charge may be made for the technical component alone; under those circumstances the technical component charge is identified by adding modifier 'tc' to the usual procedure number; technical component charges are institutional charges and not billed separately by physicians; however, portable x-ray suppliers only bill for technical component and should utilize modifier tc; the charge data from portable x-ray suppliers will then be used to build customary and prevailing profiles
59	Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25.
51	Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d).
GC	This service has been performed in part by a resident under the direction of a teaching physician
XU	Unusual non-overlapping service, the use of a service that is distinct because it does not overlap usual components of the main service
GA	Waiver of liability statement issued as required by payer policy, individual case
AQ	Physician providing a service in an unlisted health professional shortage area (hpsa)
CR	Catastrophe/disaster related
52	Reduced services: under certain circumstances a service or procedure is partially reduced or eliminated at the discretion of the physician or other qualified health care professional. under these circumstances the service provided can be identified by its usual procedure number and the addition of modifier 52, signifying that the service is reduced. this provides a means of reporting reduced services without disturbing the identification of the basic service. note: for hospital outpatient reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well-being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use).
XS	Separate structure, a service that is distinct because it was performed on a separate organ/structure
53	Discontinued procedure: under certain circumstances, the physician or other qualified health care professional may elect to terminate a surgical or diagnostic procedure. due to extenuating circumstances or those that threaten the well being of the patient, it may be necessary to indicate that a surgical or diagnostic procedure was started but discontinued. this circumstance may be reported by adding modifier 53 to the code reported by the individual for the discontinued procedure. note: this modifier is not used to report the elective cancellation of a procedure prior to the patient's anesthesia induction and/or surgical preparation in the operating suite. for outpatient hospital/ambulatory surgery center (asc) reporting of a previously scheduled procedure/service that is partially reduced or cancelled as a result of extenuating circumstances or those that threaten the well being of the patient prior to or after administration of anesthesia, see modifiers 73 and 74 (see modifiers approved for asc hospital outpatient use).
GW	Service not related to the hospice patient's terminal condition
GZ	Item or service expected to be denied as not reasonable and necessary
22	Increased procedural services: when the work required to provide a service is substantially greater than typically required, it may be identified by adding modifier 22 to the usual procedure code. documentation must support the substantial additional work and the reason for the additional work (ie, increased intensity, time, technical difficulty of procedure, severity of patient's condition, physical and mental effort required). note: this modifier should not be appended to an e/m service.
27	Multiple outpatient hospital e/m encounters on the same date: for hospital outpatient reporting purposes, utilization of hospital resources related to separate and distinct e/m encounters performed in multiple outpatient hospital settings on the same date may be reported by adding modifier 27 to each appropriate level outpatient and/or emergency department e/m code(s). this modifier provides a means of reporting circumstances involving evaluation and management services provided by physician(s) in more than one (multiple) outpatient hospital setting(s) (eg, hospital emergency department, clinic). note: this modifier is not to be used for physician reporting of multiple e/m services performed by the same physician on the same date. for physician reporting of all outpatient evaluation and management services provided by the same physician on the same date and performed in multiple outpatient setting(s) (eg, hospital emergency department, clinic), see evaluation and management, emergency department, or preventive medicine services codes.
58	Staged or related procedure or service by the same physician or other qualified health care professional during the postoperative period: it may be necessary to indicate that the performance of a procedure or service during the postoperative period was: (a) planned or anticipated (staged); (b) more extensive than the original procedure; or (c) for therapy following a surgical procedure. this circumstance may be reported by adding modifier 58 to the staged or related procedure. note: for treatment of a problem that requires a return to the operating/procedure room (eg, unanticipated clinical condition), see modifier 78.
76	Repeat procedure or service by same physician or other qualified health care professional: it may be necessary to indicate that a procedure or service was repeated by the same physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 76 to the repeated procedure or service. note: this modifier should not be appended to an e/m service.
77	Repeat procedure by another physician or other qualified health care professional: it may be necessary to indicate that a basic procedure or service was repeated by another physician or other qualified health care professional subsequent to the original procedure or service. this circumstance may be reported by adding modifier 77 to the repeated procedure or service. note: this modifier should not be appended to an e/m service.
78	Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period: it may be necessary to indicate that another procedure was performed during the postoperative period of the initial procedure (unplanned procedure following initial procedure). when this procedure is related to the first, and requires the use of an operating/procedure room, it may be reported by adding modifier 78 to the related procedure. (for repeat procedures, see modifier 76.)
79	Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period: the individual may need to indicate that the performance of a procedure or service during the postoperative period was unrelated to the original procedure. this circumstance may be reported by using modifier 79. (for repeat procedures on the same day, see modifier 76.)
95	Synchronous telemedicine service rendered via a real-time interactive audio and video telecommunications system: synchronous telemedicine service is defined as a real-time interaction between a physician or other qualified health care professional and a patient who is located at a distant site from the physician or other qualified health care professional. the totality of the communication of information exchanged between the physician or other qualified health care professional and the patient during the course of the synchronous telemedicine service must be of an amount and nature that would be sufficient to meet the key components and/or requirements of the same service when rendered via a face-to-face interaction. modifier 95 may only be appended to the services listed in appendix p. appendix p is the list of cpt codes for services that are typically performed face-to-face, but may be rendered via a real-time (synchronous) interactive audio and video telecommunications system.
AG	Primary physician
AS	Physician assistant, nurse practitioner, or clinical nurse specialist services for assistant at surgery
CA	Procedure payable only in the inpatient setting when performed emergently on an outpatient who expires prior to admission
FS	Split (or shared) evaluation and management visit
GV	Attending physician not employed or paid under arrangement by the patient's hospice provider
PD	Diagnostic or related non diagnostic item or service provided in a wholly owned or operated entity to a patient who is admitted as an inpatient within 3 days
Q1	Routine clinical service provided in a clinical research study that is in an approved clinical research study
Q6	Service furnished under a fee-for-time compensation arrangement by a substitute physician or by a substitute physical therapist furnishing outpatient physical therapy services in a health professional shortage area, a medically underserved area, or a rural area
SA	Nurse practitioner rendering service in collaboration with a physician
U2	Medicaid level of care 2, as defined by each state
X4	Episodic/focused services: for reporting services by clinicians who provide focused care on particular types of treatment limited to a defined period and circumstance; the patient has a problem, acute or chronic, that will be treated with surgery, radiation, or some other type of generally time-limited intervention; reporting clinician service examples include but are not limited to, the orthopedic surgeon performing a knee replacement and seeing the patient through the postoperative period
XE	Separate encounter, a service that is distinct because it occurred during a separate encounter