# 51040 vs 51102



## TnRushFan (Aug 24, 2020)

Hi folks, there has been some discussion in our office about suprapubic tube placement.

Some of us are under the impression that if a suprapubic tube is placed it is coded as 51102 no matter what...others of us (including myself) are of the opinion that if the provider uses a scalpel and electrocautery to dissect down to a Lowsley retractor (trans urethral placed into the bladder)  that it would be coded to 51040 and still others think that if they use the Lowsley retractor it will be coded 51040 no matter what...
I think the difference is in the dissection...not just 'puncture' or 'stab wound' of the abdomen...

Am hoping someone can clear this up for us.
I have included a scrubbed excerpt below.

"Lowsley retractor was passed through the urethra and into the bladder. 
The tip of the lowsely was palpated on the anterior abdominal wall 2 cm above 
the pubic rim.  A scalpel and Bovie electrocautery were used to cut down on the 
Lowsley catheter and it was passed through the anterior abdominal 
wall.  The 16-French council-tip catheter was attached to Lowsley 
with a 2-0 silk stitch and the Lowsley retractor was closed on the 
catheter.  The catheter was passed in an antegrade fashion through 
the abdominal wall, bladder and out the meatus.  The catheter tip was 
removed from the Lowsley retractor.  The 26-French resectoscope 
was used to visualize the tip of the catheter as it was pulled 
retrograde into the bladder."

Thanks in advance...


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## thomas7331 (Aug 25, 2020)

I can see the confusion here, but I think this thread addresses the question well:


			https://www.aapc.com/discuss/threads/cystoscopy-with-suprapubic-tube-plaement.111756/
		


51040 is an open procedure and would be expected to be performed under anesthesia in a facility operating room.  51102 is the minimally invasive procedure which can be done in the office.  I think it could be misleading to use the scalpel & dissection as the criteria for this because both procedures will involve these.  The procedure excerpt you've posted above seems to me to fall under 51102 as the intent of the incision is simply to create the point for the catheter placement and not to access the bladder in an open fashion.  Perhaps someone with more experience in urology coding can help clarify this though.


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## TnRushFan (Aug 25, 2020)

thomas7331 said:


> I can see the confusion here, but I think this thread addresses the question well:
> 
> 
> https://www.aapc.com/discuss/threads/cystoscopy-with-suprapubic-tube-plaement.111756/
> ...



Thank you Thomas, I appreciate your input.

I agree that if in the office setting or 'in patient' bedside 51102 but this was performed in the operating room under general anesthesia...this is where our office conversation gets interesting...but none of us confident in our professional opinions.


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## daniel (Aug 27, 2020)

Lowsley retractor= 51040


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## thomas7331 (Aug 27, 2020)

daniel said:


> Lowsley retractor= 51040



Do you have a source for this guidance that you could share?


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## daniel (Aug 27, 2020)

See the attached item.
Keep in mind I've always used CPT 51102, but recently my provider gave me some push back on the use of Losley retractor techinque. So I looked further into this, think this supports my use of 51040 now.
But to throw another curve ball, I just found a clinic article implying that this falls under the percutaneous placement. 51102.. So use discretion, as of now. Personally I can back the use of 51040 with my compliance dept. But if they said nope, I could see CPT 51102 being the standard. 
Confusing.. 



			https://www.audioeducator.com/archive/insights-on-the-coding-for-bladder-catheters.html
		


While doing a suprapubic insertion, use the code 51040 for a suprapubic open cystotomy with drainage. Now, there are many confusion concerning the use of a cystotomy with a Lowsley retractor (that is Lowsley retractors placed per urethra). It's depressed so that the blades of the Lowsley retractor which are closed are felt through the abdominal wall through the bladder. And what the urologist does when he feels this Lowsley retractor in the dome of the bladder, he make an incision through the skin, the subcu, the anterior rectus fascia, the muscles, the perivesical fascia and makes an incision in the bladder itself. This is a cystotomy, although it may be smaller than the standard, it is a cystotomy so you would also use in this case the 51040.


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