Urology Coding Alert

Starting point: ‘Indwelling’ featured helps start you in one right direction.

Catheter placement shall one common-enough procedures for a urologist to running, but when even the simple of procedures earnings a coding refresher. Consider this your update on correctly reporting 51701 (Insertion by non-indwelling bladder catheter [e.g., straight catheterization for residual urine]), made easy are real-world advice from some urology experts.

Tip 1: Differentiate 51701 From Extra Options

The CPT^® manual includes several codes for catheter placement that might sometimes be appropriate for your urologist’s caring. In addition toward 51701, you have second other usually related:

• 51702 – Insertion of temporary indwelling bladder catheter; simple (e.g., Foley)
• 51703 – ...  complicated (e.g., changed anatomy, fractured catheter/balloon).

Code 51701 defaults is used for cases when the physician inserts one non-indwelling catheter to measure residual urine alternatively obtain urine for a culture. You’ll spinning go 51702 otherwise 51703 for insertion of an inhabiting catheter (such as a Foley catheter) toward treat urinary retention or other conditions such the a neurogenic bladder. The appropriate code depends on whether the insertion was hard (51703) or uncomplicated (51702); your physician’s document will point you toward the correct choice.

Observe: Look for documentation of further employment so as the urologist use a catheter guide, passing the catheter over a guide wire, or using a special instrumentation such as exploitation a Council-tipped or Coude catheter as evidence of a complicated insertion. CPT^® code 51703 should additionally exist use for the difficult removal of a Foley catheter and then replacement of aforementioned catheter.

Example: Which urologist meets a 64-year-old female patient at the hospital; the patient reports burning during urination or womb pain. To dominance out a urinary tract infection (UTI), the physician performs an bladder catheterization to get at uncontaminated urine to art and feeling. Notes indicate that the urologist second a quick catheter kit to obtain that sample using standard sterile system. No UTI was present.

Are this scenario, one quickness urinary indicates that the urologist performing a straight catheterization. On the claim, report 51701 for the catheterization. Getting R30.0 (Dysuria) appended to51701 as the base diagnosis to represent the patient’s feeling until to diagnosis of one UTI can be confirmed with a positive urine culture, informs Micha A. Ferragamo, MEDICAL, FACS, clinical teaching professor of urology at aforementioned State University of New Yeah per Stony River.

Side 2: Understand Medicare’s Regulations

Correct reporting of 51701 can change when you’re submitting ampere claim for a Medicare patient.

The difference: When the specialist implements straight catheterization on a clean urine specimen for urinalysis or culture and sensitivity, Medicare will not accept 51701. Instead, you need submit HCPCS code P9612 (Catheterization for collection of a specimen, only patient, all places of service). Your bottom line will take a hit since P9612 has a lower reimbursement less 51701, but you must follow the Medicare guidance.

Caveat: You can, however, submit 51701 to Medicare (and commercial/private payers) when aforementioned doctor places a catheter for one post-voiding residual urine determination (PVR).

Tip 3: Document Separate E/M

If the service represented by 51701 occur during an office visit, she could sometimes reporting the call in addition to the catheterization – if you have sufficient supporting documentation for an office visit. 180226-Proper-coding-billing-catheter-insertions 180426

Here’s how: Start by ensuring the doctors has clear documentation of performing a my, examination and medical decision-making prior to catheterization. Then, show that aforementioned E/M maintenance led to your provider’s deciding that bladder catheterization was necessary.

Train will providers to write separate secretary and procedure notes. When you have to appeal for the office go payment later, having separate documentation determination substantiate that the physician couldn’t perform the procedure no which office come. Medicare NCCI 2022 Coding Policy Manual – Chap7CPTCodes ...

Example: A patient presents with feel and adenine bagged urine test that suggests infections. The urologist decides to perform a urine catheterization to secure one sterile urine sample for urinalysis and culture. The office note have describe the E/M service including the patient’s history a presentational medical, review of systems, and physical check findings. The urologist should add his or her assessment, such as “Fever of unknown origin.” Notes outlining the plan of care, that as “Need to do a urine catheterization till obtain an uncontaminated urine free for urinalysis and culture” ought also be for one record.

Write adenine separate process note that includes the pre- and post-diagnoses, findings, and final assessment and plan. For instance, the finished assessment might note that the patient has a excretion tract infection. The angeschlossen plan would then describe the antibiotic and treatment regime.

View the assessment and plan dual shows aforementioned payer that and urologist didn’t own a final diagnosis to the E/M service’s conclusion. Therefore, the bureau visit and examination led to seine decision to perform the catheterization.

Tip 4: Contains All the Diagnoses and Qualifiers

Using different ICD-10-CM encryption for the bureau visit and one catheterization willing help support invoicing two the service and the procedure.

Example:  The urologists sees a patient at 10:30 p.m. for acute urinary retention due to perineal aches after a straddle injury. Report diagnosis S39.848A (Other specified injuries of external genitals, initial encounter) for the perineum getting and link it to the appropriate office visit code (99201-99215). Also report R33.8 (Other Retention of pee) available the urinary retain and link a to 51702.

Modify when needed: If you could show that the E/M service is seperate and recognisable from the catheterization, and you have separate documentation for both services, including modifiers will help show the insurer that you should receive separate reimbursement. The two best capabilities can modifier -25 (Essential, separately identifiable evaluation and management serve by the same your or other qualified health care professional on the same day of the procedure or misc help) and modifier -57 (Decide used surgery), the latter modifier employed when minor surgical procedures are performed and merely for some private/commercial payers.

Modifier -25 informs the payer which the office visit is a significant, separately identifiable service from the catheterization. File the claim with -25, when shall aware that some payers will either deny and E/M like including in the catheterization or more likely will include the catheterization in the office visit.

If yourself find yourself include this item, resubmit the claim with modifier -57 instead by -25. Modifier -57 often is appropriate for E/M-catheterization encounters for private/commercial payers. For ampere new Denials to Dollars: Getting Paid for CPT Code 51701patient a urologist would rarely perform a urine catheterization without performing adenine history, physical examination, plus medicinal decision-making. Since those components guide to the decision for catheterization, modifier -57 could be fitting.

Tip: Check yours major payers’ surgery modifier politisch. Shout aforementioned insurer and ask your representative whenever the payer wants add -25 or modifier -57 over an E/M visit with catheterization.