Pediatric Coding Alert

Sometimes pediatricians must go to the hospital when a VUCG (voiding urethrocystography, CPT 74455 ) is done. The pediatrician must be there to catheterize the child, notes Joanne Paluck, office manager of Southampton Pediatrics, a five-pediatrician practice in Southampton, NY. How should this be coded? she asks.

This question most often comes up in community hospitals, where there arent staff members to perform the catheterization. In these instances, the pediatrician should code for the catheterization only: 53670 (catheterization, urethra; simple) or 53675 (catheterization, urethra; complicated [may include difficult removal of balloon catheter]). The pediatrician cant code for any other services, even though it does take time to get to the hospital for the procedure, explains Georgeann Bremer, CPC, RN, coding analyst for ESR Satellite Operations, part of the ESR Health System in Atlanta, where there are 800 pediatricians. The only way the pediatrician can bill for something else related to the catheterization is if the radiologist asked for a consultation, says Bremer. If the radiologist asks the pediatrician to do the catheterization and also to consult on the case, then the pediatrician can use a consultation code (99241-99245) in addition to the catheterization code, she says.

Tip: Remember you can do a consultation on your own patient if you are doing this for another doctor.

And Elizabeth Banko, administrator of St. Peters Pediatric Faculty Group in New Brunswick, NJ, agreescatheterization is the only code that can be billed unless there is a consult. And the consultation would have to be done for some reason other than just performing the catheterization. For example, if the child had a recurrent urinary tract infection, or a fever, or something else that called for more information to give to the radiologist, the pediatrician could then bill for the consultation.