Ob-Gyn Coding Alert

Question: I have a doctor that was wondering if we could code a separate code for catheter drainage when we do a 56420. I feel like the catheter drainage (C1729?) would be included in the 56420, but I am new in the ob/gyn field and wanted another opinion if possible. What should I do?

Illinois Subscriber

Answer: Code 56420 (Incision and drainage of Bartholin’s gland abscess) includes all supplies when performed in the office setting. However, you need to look at the included supplies to know if you can bill a drain, such as a Word Bartholin catheter, in addition. 

Per the AMA’s CPT^® RBRVS database, the code’s practice expense RVUs were based on the following list of supplies:

• Pack, cleaning, surgical instruments;
• pack, minimum multi-specialty visit;
• pack, pelvic exam;
• needle, 18-27g syringe 10-12 ml;
• applicator, cotton tipped, non-sterile 6 in;
• lidocaine 1%-2% injection;
• povidone solution; and
• swab pad, alcohol.

As you can see, the intent of this procedure is to immediately drain the incision of its contents. Placement of a Word catheter into the cyst or abscess is an additional step that allows the contents to drain and, over time, to form a fistulous tract around the catheter. You won’t find a Word catheter that is inserted for additional drainage on this list and therefore, you could code it separately. 

However, C-codes are unique temporary pricing codes established by Medicare for their Prospective Payment System and are only valid for Medicare on claims for hospital outpatient department services and procedures. In the office setting, you would have to bill 99070 (Supplies and materials [except spectacles], provided by the physician or other qualified health care professional over and above those usually included with the office visit or other services rendered [list drugs, trays, supplies, or materials provided]) for the Word catheter. You would submit proof of your invoice cost in supplying the catheter with your request for reimbursement.