# Catheter Change



## KaylaRieken (May 6, 2019)

Not sure if I should bill this as a complicated catheter change 51703. Or a UD 53661 (he's been dilated before by us) and then the 51702 (regular catheter code) is bundled so I wouldn't be able to charge for that. The 53661 and the 51703 is bundled but I can unbundle with a 59. Not sure what the correct way to do this is. Diagnosis codes are Urinary Retention and Urethral Strictures.

I inspected the opening at the end of the shaft. I did pass a 0.035 Glidewire through a small opening and elected this will be advanced into the bladder. Following this, the implants dilators then used to dilate the urethral opening and diffuse urethral strictures throughout the urethra and this was quite difficult. The patient had discomfort and we had to eventually give him a total of 6 mL of morphine and 2 of Versed as we progress through the procedure to have him tolerate this dilation which was quite firm and rigid through the urethra. After I was able to dilate to 18 French, I then made a council-tip catheter out of a 14-French catheter by passing the needle through the tip and then passing this over the Glidewire. This actually went in relatively easily and obtained clear urine. The balloon was inflated with 10ML sterile water. This was connected to gravity drainage. After approximately 400 mL, I did clamp the urine bag and asked the nurse to release that in 15 minutes or so. 

Any help would be greatly appreciated. When catheters get changed with UDs it confuses me


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## meghanhannus (May 6, 2019)

Hello KaylaRieken,

I would only code CPT 51703 since the insertion was complicated by the altered anatomy of urethral stricture. Also, I know you are not billing CPT 53661 but that code is specifically for the female urethra.

Hope this helps~


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## KaylaRieken (May 6, 2019)

Yes, Sorry I meant to put 53601.   So I should still bill the 51703 even though the CCI edits say 53601 - 51703 - 1? So the 59 would be on the 51703.


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## meghanhannus (May 6, 2019)

Hello,

It's ok  

CPT 53601 should not be billed in addition to CPT 51703 as the dilation is included as the complication due to urethral stricture.
So I would only bill CPT 51703 _(Insertion of temporary indwelling bladder catheter; complicated)_


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## KaylaRieken (May 6, 2019)

Right. And that's what I have been billing. Only the 51703. And then I  looked in the CCI edits and in column one it has the 53660 and then column two 51703. And column 3 the 1. So its ok to choose to only bill the 51703? Am I making any sense? I didn't know you could choose which code you were going to use?


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## meghanhannus (May 6, 2019)

KaylaRieken said:


> Right. And that's what I have been billing. Only the 51703. And then I  looked in the CCI edits and in column one it has the 53660 and then column two 51703. And column 3 the 1. So its ok to choose to only bill the 51703? Am I making any sense? I didn't know you could choose which code you were going to use?



Yes, it is okay. In this scenario it would be bundling as we are selecting the complicated insertion due to the dilation of stricture.


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## KaylaRieken (May 7, 2019)

Alright. Thank you so much. That is the way I have been coding, but for some reason I was second guessing myself.


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