Urology Coding Alert

Learn when to report P9612 versus 51701.

Sometimes your urologist may need to insert a non-indwelling bladder catheter. In this case, you would report this service with code 51701 (Insertion of non-indwelling bladder catheter (eg, straight catheterization for residual urine)). However, if you don’t know how to appropriately report an evaluation and management (E/M) service with 51701, you could be leaving money on the table.

Follow three simple steps to always submit clean bladder catheter placement claims in your practice.

Step 1: See Different Codes for Bladder Cath Placement

CPT^® identifies several codes for bladder catheter placement. Besides 51701 for a non-indwelling, you have two other common alternatives for indwelling catheters:

• 51702 (Insertion of temporary indwelling bladder catheter; simple (eg, Foley)
• 51703 (… complicated (eg, altered anatomy, fractured catheter/balloon))

Code 51701: You will use code 51701 when your urologist inserts a non-indwelling catheter to measure residual urine or obtain a clean urine for a urinalysis or culture.

Code 51702: You should report 51702 for the insertion of an indwelling catheter, like a Foley catheter, to treat urinary retention or other conditions such as a neurogenic bladder. This code is for a simple insertion.

Code 51703: You should report 51703 for the complicated insertion of an indwelling catheter. For example, if the patient previously had an injury to the urethra that might have caused scar tissue or a stricture, or possibly when a false passage was created by a prior attempt to place a catheter, this might warrant a complicated insertion code. Your urologist should make the determination of difficulty and should subsequently document the degree of difficulty encountered to support the complicated catheter placement. This clinical scenario will include the initial passage of a wire per urethra to allow catheter passage over the wire, the use of a catheter guide, the necessity of initially instilling lubricating jelly into the urethra to allow passage of the catheter, and the use of a coude catheter for catheter passage, explains Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology, State University of New York, Stony Brook.

Step 2: Grasp Medicare’s Rules for 51701

Medicare has specific rules for reporting code 51701. For example, when your urologist performs straight catheterization for a clean urine specimen for urinalysis or culture and sensitivity, Medicare will not accept code 51701. In this case, you should report HCPCS code P9612 (Catheterization for collection of specimen, single patient, all places of service). For non-Medicare patients you should still use code 51701 (Insertion of non-indwelling bladder catheter [eg, straight catheterization for residual urine]) for the same catheterization procedure.

Medicare will not reimburse the higher fee for a simple catheterization to obtain a urine specimen. Remember you should use P9612 only for Medicare patients. However, you can, and should, use 51701 for both Medicare and commercial/private carriers for a catheterized post-voiding residual urine determination (PVR).

Step 3: Report Separate E/M Service

If your urologist performs a 51701 service during an office visit, you may be able to report the E/M visit in addition to the catheterization.

First, you must make sure you have sufficient documentation to support the performance of a history, exam, and medical decision-making (MDM) prior to the catheterization. The documentation must also show that the E/M service led to your urologist’s decision that the bladder catheterization was necessary.

Example: The urologist performed and documented a medically necessary E/M service related to the cause of the residual urine requiring catheterization. The urologist performed a medically appropriate history and exam, as well as moderate level of MDM. The established patient needed an in/out catheter for residual urine.

You could report 99214 (Office or other outpatient visit for the evaluation and management of an established patient, which requires a medically appropriate history and/or examination and moderate level of medical decision making. When using time for code selection, 30-39 minutes of total time is spent on the date of the encounter.) with modifier 25 (Significant, separately identifiable evaluation and management service by the same physician or other qualified health care professional on the same day of the procedure or other service) appended, in addition to 51701 for the catheterization.