Oncology & Hematology Coding Alert

Question: For a patient with a urinary catheter, can we bill for the Foley itself when reporting a Foley replacement? If we give the patient a few straight catheters, can we bill for the supplies?

New Mexico Subscriber

Answer: For the Foley catheter change, you submit code 51702 (Insertion of temporary indwelling bladder catheter; simple [eg, Foley]). This code includes the cost of the catheter. You do not charge the patient additional for the catheter in a physician office setting.

If you have a durable medical equipment (DME) number, you may bill the durable medical equipment regional office (DMERO) for additional catheters you gave to the patient for home use. You will receive payment as long as the problem or need for the catheters will exist for at least three months.

Avoid charging to patient:  Few oncologists charge the patient for these catheters and should only do so when they have a DME number. Instead, you should give the patient a prescription for the catheters, to be dispensed by a durable medical supplier or an independent surgical supply company. Participating suppliers bill dispensed supplies to the Medicare Durable Medical Equipment, Prosthetics/Orthotics & Supplies (DMEPOS) Administrative Contractor (DME MAC).