# Bladder Debris w/ UTI



## vallancm (Sep 26, 2014)

I have a doctor who frequently suctions out "bladder debris" using a syringe. The patients always have a UTI, so I think he is cleaning out infection. I have a co-worker who codes this as foreign body removal, but I don't think that would be correct. If the doctor is performing a cystoscpy, then cleans out this "debris", would it be considered part of the cystoscopy procedure? How would you code the following?


ANESTHETIC:  General.

 PREOPERATIVE DIAGNOSIS:  Chronic urinary tract infection.

 POSTOPERATIVE DIAGNOSIS:  Chronic urinary tract infection.

 OPERATION:  Cystoscopy with evacuation of bladder debris.

 ESTIMATED BLOOD LOSS:  Zero.

 DRAIN:  None.

 POSTOPERATIVE CONDITION:  Good.

 DESCRIPTION OF PROCEDURE:  The patient was prepped and draped in the usual sterile fashion in dorsal lithotomy position.  A 20-French ACMI scope was inserted into the bladder.  A large amount of bladder debris was evacuated utilizing a Toomey syringe.   There were no tumors, diverticulum, or calculi.  Both ureteric orifices were effluxing clear urine.  The patient tolerated the procedure well and was returned to the recovery room in satisfactory condition.


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## nateich (Sep 27, 2014)

52005 is probably your best bet; I am confident that 52310-52315 are not correct.


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## emcee101 (Sep 29, 2014)

52005 - Cystourethroscopy, with *ureteral catheterization*, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service;  

The above is for URETERAL catheterization. nowhere in your op note is this mentioned so this should not be coded. The work being done is similar to 52001 (Cystourethroscopy with irrigation and evacuation of multiple obstructing clots), but your doctor is irrigating and evacuating debris and not obstructing clots. If you feel it is worth the work involved, you could bill an unlisted code and associate the work to 52001.


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## nateich (Sep 29, 2014)

After reading emcee101 response, I went back and read thru some articles; this may be of assistance:

Reader Questions: Add 51700 For Documented Barbotage
- Published on Tue, Apr 19, 2011

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Question:

Can I code for bladder barbotage the urologist does while the patient is also having a cystoscopy?

West Virginia Subscriber

Answer:

If you urologist's documentation does indicate he performed a barbotage procedure, you can report 51700 (Bladder irrigation, simple, lavage and/or instillation). You'll also report 52000 (Cystourethroscopy [separate procedure]) for the cystoscopy.

Additionally: 

Append modifier 59 (Distinct procedural service) to 51700 to indicate the barbotage is separate from the cystoscopic work.


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## vallancm (Sep 30, 2014)

That sounds more along the lines of what I was thinking. Thanks!


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