ED Coding and Reimbursement Alert

Question: A patient with a swollen prostate (prostatitis) reports to the ED complaining of trouble with his suprapubic cystostomy tube. Upon examination, the physician discovers that the tube is worn and has fallen out of place. To facilitate the replacement, the physician dilates the urinary tract, and then replaces the tube; is this a simple or complicated tube replacement?

Utah Subscriber

Answer: The need to dilate the tract before replacing the tube can make this procedure complicated rather than simple. You will, however, need to check the notes for evidence of guidance before choosing the correct code.

No guidance: If the physician did not need guidance during the encounter, report only 51710 (Change of cystostomy tube; complicated) with 601.9 (Prostatitis, unspecified) appended to represent the patients prostate trouble.

Guidance: If the physician uses guidance during the procedure, report the following:

" 51710 for the tube change

" 75984 (Change of percutaneous tube or drainage catheter with contrast monitoring [e.g., genitourinary system, abscess], radiological supervision and interpretation) for the guidance

" modifier 26 (Professional component) appended to 75984 to show that you are only coding for the professional portion of the service

" 601.9 appended to 51710 and 75984 to represent the patients condition.