Urology Coding Alert

Question: Can I report a code for a Foley catheter insertion if it was inserted through a cystoscopy over a guide wire, or is the catheterization considered included in the cysto? The urologist attempted a standard catheterization, but after many failed attempts he decided to insert it via cystoscopy using a guide wire and urethral dilation.

Wisconsin Subscriber


Answer: Whether you separately report this complex catheterization service really depends on which carrier will receive the claim.

 The multiple failed attempts at standard catheterization may imply an anatomic abnormality and therefore classify the catheterization as "complicated," represented by 51703 (Insertion of temporary indwelling bladder catheter; complicated [e.g., altered anatomy, fractured catheter/balloon]).

 According to the National Correct Coding Initiative (NCCI) edits, however, 51703 and 52000 (Cystourethro-scopy [separate procedure]) can never be billed together, regardless of the circumstances. This means that for all Medicare carriers and those private carriers that adhere to the NCCI edits, you should only use the code for cystourethroscopy and urethral dilation, 52281 (Cystourethroscopy, with calibration and/or dilation of urethral stricture or stenosis, with or without meatotomy, with or without injection procedure for cystography, male or female). This code also includes the placement of a Foley catheter (51702 and 51703).