Wiki Methylene Blue Tampon Dye Test Procedure

[dmarshall]

Good morning OBGYN Group,

Wanted to ask if we have a code for the Methylene Blue Tampon Dye Test in which the patient was not taken back to the OR, I have researched and I saw a while back that we should use the unlisted code and compare it to 57150 and then I read something on the AUGS site that said it would probably bundle into the E&M code. This patient had a LAVH on 03/21/23 and was admitted on 03/24/23 with post op complications and doctor performed test due to suspicion of a bladder injury since patient was experiencing vaginal discharge.

Methylene Blue Tampon Dye Test Procedure Note

Patient inserted a clean, dry tampon into the vagina. Approximately 10 cc of methylene blue was injected into a 1000 cc bag of normal saline and mixed. Foley catheter was inserted into the bladder in a sterile fashion. The catheter drained approximately 20 cc clear yellow urine s/p Pyridium administration. The foley catheter was kinked. One hundred cc of the saline-methylene blue mixture was slowly injected, back-filling the bladder. Patient unable to tolerate any further volume administration past 100cc. The foley catheter was then removed. The patient was instructed to walk for 20 minutes.
The caudal end of the tampon was visible at the introitus and was removed. Scant blue was noted on the caudal end which was attributed to foley catheter removal. A new tampon was then inserted by the patient further into the vagina after verifying there was no methylene blue on the vulva. She walked for an additional 20 minutes.

Result: Tampon clean. No orange or blue coloration.
Impression: No apparent bladder injury, vesicovaginal or ureterovaginal fistula

And then the other question I have is that the patient was seen by two of our OBGYN doctors on the same day, one saw the patient for the hospital visit and then another one of our OBGYN doctors within the same tax ID of our group did the Dye test procedure, not sure how that would work. ?????


Thank you for your assistance!

 

[nielynco]

Good morning OBGYN Group,

Wanted to ask if we have a code for the Methylene Blue Tampon Dye Test in which the patient was not taken back to the OR, I have researched and I saw a while back that we should use the unlisted code and compare it to 57150 and then I read something on the AUGS site that said it would probably bundle into the E&M code. This patient had a LAVH on 03/21/23 and was admitted on 03/24/23 with post op complications and doctor performed test due to suspicion of a bladder injury since patient was experiencing vaginal discharge.

Methylene Blue Tampon Dye Test Procedure Note

Patient inserted a clean, dry tampon into the vagina. Approximately 10 cc of methylene blue was injected into a 1000 cc bag of normal saline and mixed. Foley catheter was inserted into the bladder in a sterile fashion. The catheter drained approximately 20 cc clear yellow urine s/p Pyridium administration. The foley catheter was kinked. One hundred cc of the saline-methylene blue mixture was slowly injected, back-filling the bladder. Patient unable to tolerate any further volume administration past 100cc. The foley catheter was then removed. The patient was instructed to walk for 20 minutes.
The caudal end of the tampon was visible at the introitus and was removed. Scant blue was noted on the caudal end which was attributed to foley catheter removal. A new tampon was then inserted by the patient further into the vagina after verifying there was no methylene blue on the vulva. She walked for an additional 20 minutes.

Result: Tampon clean. No orange or blue coloration.
Impression: No apparent bladder injury, vesicovaginal or ureterovaginal fistula

And then the other question I have is that the patient was seen by two of our OBGYN doctors on the same day, one saw the patient for the hospital visit and then another one of our OBGYN doctors within the same tax ID of our group did the Dye test procedure, not sure how that would work. ?????


Thank you for your assistance!

The procedure would be 51700 for the instillation of the methylene blue during the postop period for the surgery. The hospital visit is probably not billable as it may have been at the normal rounding visit, but the procedure can be billed but the only question is which modifier would get it paid (-58, -78, or -79)? It is not planned per se and is diagnostic, not therapeutic in nature (so not quite -58) but is is also not a return to the OR or using a procedure room as it appears this procedure may have been done at her bedside (so not quite -78). And of course it would not be -79 as this procedure is directly related to surgery recovery. So pick one that works and see what happens. I do not think you can call this procedure included in normal pre-operative care and therefore should be billed.

 

[dmarshall]

The procedure would be 51700 for the instillation of the methylene blue during the postop period for the surgery. The hospital visit is probably not billable as it may have been at the normal rounding visit, but the procedure can be billed but the only question is which modifier would get it paid (-58, -78, or -79)? It is not planned per se and is diagnostic, not therapeutic in nature (so not quite -58) but is is also not a return to the OR or using a procedure room as it appears this procedure may have been done at her bedside (so not quite -78). And of course it would not be -79 as this procedure is directly related to surgery recovery. So pick one that works and see what happens. I do not think you can call this procedure included in normal pre-operative care and therefore should be billed.

Thank you so much Melanie, I appreciate your knowledge and guidance.