ED Coding and Reimbursement Alert

Question: A patient reports to the ED complaining of urinary symptoms; he says that he "hasn't peed since yesterday," and he reports a 7 on a 10-point pain scale. Notes indicate that following several attempts by the nurse, the physician easily inserts a "coude tip catheter" to drain the urine. Is the catheter insertion part of the E/M? Oregon Subscriber Answer: Provided the physician inserted the catheter himself, and the patient meets the insurer's requirements for catheter insertion, you can separately report it. On the claim, report the following: • 51702 (Insertion of temporary indwelling bladder catheter; simple [e.g., Foley]) for the insertion • the appropriate level ED E/M code based on the notes (99281-99285, Emergency department visit for the evaluation and management of a patient, which requires these 3 key components: ...) • modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same [...]