Urology Coding Alert

Question: How do you code a cystoscopy with suprapubic catheter incision?

Oregon Subscriber

Answer: To correctly code a cystoscopy with suprapubic catheter insertion, it is necessary to know whether the suprapubic catheter was inserted percutaneously or by incision. For a percutaneous suprapubic catheter placement, report code 51010 (aspiration of bladder; with insertion of suprapubic catheter) when a trocar or intracatheter is inserted through the skin and a suprapubic catheter is placed into the bladder. A diagnostic cystoscopy (52000) may be reported in addition to 51010.

If a suprapubic catheter is placed after the physician creates an opening into the bladder through an incision (cystostomy), report code 51040 (cystostomy, cystotomy with drainage) with the cystoscopy procedure. CPT has designated cystoscopy (52000) as a separate procedure and, therefore, some payers may deny payment when reported with 51010 or 51040. This would be an incorrect denial, and you should resubmit your claim explaining that a cystoscopy is not an integral part of the catheter insertion. No modifier is necessary because the codes are not bundled.