Indwelling Catheter Insertions That Can Plug Your Revenue Stream

Indwelling Catheter Insertions That Can Plug Your Revenue Stream

These procedures may seem straightforward, but don’t let your guard down when coding them.

Every surgical specialty has a set of staple procedures that seasoned coders know like the back of their hand. Take indwelling bladder catheter insertion, for example. While the coding processes are typically second nature to urology coders, the complexity of the procedure will have the final say on how smoothly things run. Put your coding skills to the test with this tricky catheter insertion scenario.

Code This Example

A patient with acute urinary retention (AUR) resulting in lower urinary tract obstruction receives an emergency urethral catheterization to decompress the bladder. The Foley catheter is left in place and the patient is transferred to outpatient care. A subsequent ultrasound (US) scan of the urinary bladder, interpreted by the treating urologist, reveals that the underlying cause of the AUR is benign prostatic hyperplasia. The emergency services performed to treat this patient’s urinary tract obstruction are relatively straightforward.

In the CPT® Index, looking up Catheter/Catheterization > Bladder > Insertion narrows your choice down to the following codes:

51701    Insertion of non-indwelling bladder catheter (eg, straight catheterization for residual urine)

51702    Insertion of temporary indwelling bladder catheter; simple (eg, Foley)

51703    Insertion of temporary indwelling bladder catheter; complicated (eg, altered anatomy, fractured catheter/balloon)

Since you have documentation supporting that the catheter remained in place, you can immediately rule out code 51701. Your choice between codes 51702 and 51703 depends on whether the surgeon encountered any underlying difficulty placing the catheter. For example, the patient may have previously had an injury to the urethra that caused scar tissue or a stricture.

In the end, only the physician can make the determination of difficulty and should, therefore, document the degree of difficulty encountered to support a complicated catheter placement. Without that documentation, you should report code 51702 for the catheter placement.

Next, you must decide on the correct code for the US of the bladder. Since only one organ was imaged, you can rule out 76770 Ultrasound, retroperitoneal (eg, renal, aorta, nodes), real time with image documentation; complete. As the CPT® code book explains, there must be documentation of the kidneys, abdominal aorta, common iliac artery origins, inferior vena cava, and any demonstrated retroperitoneal abnormality to report the complete retroperitoneal US code (76770). When that criterion isn’t met, or the scan is performed on a single organ or quadrant, you’ll report the limited code: 76775 Ultrasound, retroperitoneal (eg, renal, aorta, nodes), real time with image documentation; limited. Make sure to append modifier 26 Professional component to 76775 if the urologist only interpreted the scan and does not own the equipment in the hospital.

Check for Edits

Now that you’ve got your codes, the last step is checking for National Correct Coding Initiative (NCCI) procedure-to-procedure (PTP) edits between 51702 and 76775. In this case, you’ll find an existing modifier indicator of “1” between these codes, with 51702 being the column 2 (and lower-valued) code. To determine whether you can unbundle these codes using modifier 59 Distinct procedural service or the appropriate X{EPSU} modifier, you’re going to need a little more information.

In Chapter 7 (CPT® codes 50000–59999) of the NCCI Policy Manual, there are multiple mentions of code range 51701–51703. Some of these guidelines explain that codes 51701–51703 are included in the global surgery package. Therefore, it would not be appropriate to report these codes with a procedure that has a global period of 0, 10, or 90 days.

Since a retroperitoneal US is not a surgery and is not assigned global days, you could reasonably conclude that 51702 and 76775 may be reported together with an unbundling modifier — but not so fast. When considering unbundling codes with a modifier indicator of “1,” you should make it habit to read through each of the codes’ respective NCCI Policy Manual chapters, if different. In this case, that means also examining all the relevant NCCI guidelines within Chapter 9 (CPT® codes 70000–79999).

If you make your way to section D Interventional/Invasive Diagnostic Imaging, you’ll come across the following guideline that changes the coding fabric of this scenario:

When urologic radiologic procedures require insertion of a urethral catheter (e.g., CPT® code 51701–51703), this insertion is integral to the procedure and is not separately reportable.

This excerpt provides you with an unequivocal answer to your coding question: You should not report code 51702 with 76775-26. No overriding modifier is appropriate in this instance.

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Brett Rosenberg

About Has 12 Posts

Brett Rosenberg, MA, CPC, COC, CCS-P, serves as the editor of The Coding Institute’s (TCI’s) Radiology, Otolaryngology, and Outpatient Facility Coding Alerts. He earned his bachelor’s degree in psychology from the University of Vermont in 2011 and his master’s degree in psychology from Medaille College in 2016. Rosenberg is affiliated with the Flower City Professional Coders local chapter in Rochester, N.Y.

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