ED Coding and Reimbursement Alert

Step one: Identify “indwelling.”

If you’re reporting 51701 (Insertion of non-indwelling bladder catheter [e.g., straight catheterization for residual urine]) for every catheter insertion your ED performs, you could be missing out on reimbursement. Check out this quick primer on how to report catheterization codes.

Tip 1: Differentiate 51701 From Other Options

The CPT^® manual includes several codes for catheter placement that might sometimes be appropriate for your services. In addition to 51701, you have two other common alternatives:

• 51702 – Insertion of temporary indwelling bladder catheter; simple (e.g., Foley)
• 51703 – ... complicated (e.g., altered anatomy, fractured catheter/balloon).

Code 51701 normally is used for cases when the provider inserts a non-indwelling catheter to measure residual urine or obtain urine for a culture. You’ll turn to 51702 or 51703 for insertion of an indwelling catheter (such as a Foley catheter) to treat urinary retention or other conditions such as a neurogenic bladder. The appropriate code depends on whether the insertion was complicated (51703) or uncomplicated (51702); your physician’s documentation will point you toward the correct choice.

Watch: Look for documentation of extra work such as the provider using a catheter guide, passing the catheter over a guide wire, or using a special technique such as using a Council-tipped or Coude catheter as evidence of a complicated insertion. CPT^® code 51703 should also be used for the difficult removal of a Foley catheter and then replacement of the catheter.

Tip 2: Understand Medicare’s Rules

Correct reporting of 51701 can change when you’re submitting a claim for a Medicare patient.

The difference: When the provider performs straight catheterization for a clean urine specimen for urinalysis or culture and sensitivity, Medicare will not accept 51701. Instead, you should submit HCPCS code P9612 (Catheterization for collection of a specimen, single patient, all places of service). Your bottom line will take a hit since P9612 has a lower reimbursement than 51701, but you must follow the Medicare guidelines.

Caveat: You can, however, report 51701 to Medicare (and commercial/private payers) when the provider places a catheter for a post-voiding residual urine determination (PVR).

Tip 3: Include All Diagnoses

Don’t forget to report all the diagnoses that the physician treats – not just the one(s) linked to the catheterization.

Example: The ED physician sees a patient at 10:30 p.m. for acute urinary retention due to perineal pain after a straddle injury. Report diagnosis S39.848A (Other specified injuries of external genitals, initial encounter) for the perineum injury and link it to the appropriate ED code (e.g., 99283).  Also report R33.8 (Other retention of urine) for the urinary retention and link it to 51702.