Wiki Problems with catheter codes?

dmcopel@hotmail.com

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Can you please help me, I'm confused.....

Does CPT code 51701 need to have a modifier attached?

Example 1: Patient with Medicare insurance has vulvar lesion with postmenopausal bleeding that is biopsied. Codes used were 99213-25, 51701, 56605-59, & 58100-59. For Number 3 Office Call, straight catheterization, biopsy of vulva, & Endometrial biopsy.

Example 2: Patient with BC/BS insurance comes in for urodynamics testing, no Office Call. Codes used were 51701, 51728, 51741, 51784, 51797. For straight catheterization, complex CMG with bladder voiding pressure, complex uroflow, EMG, abdominal pressure, add on code.

I did not use one because the CPT book does not list this code as a separate procedure and I used a 25 modifier on Example 1 for the Office Call. I'm getting more cofused the longer I look at this and try to figure out why. Please help!!

Thank you!
 
Debbie,

It appears that your problem in both of these examples is that CPT 51701 bundles with other procedures performed. In the case of example 1, it bundles with 58100. In the case of example 2, it bundles with 51728, 51741 and 51784.

51701 is a column 2 code with all of these codes with the CCI edit rule "standards of medical/surgical practice." Basically, what this means is that the procedure described by 51701 is considered to be an integral or inclusive part of these other procedures, and therefore, not billable.

Sincerely,

Drew Vinson
CPC
NW Urology
 
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