Pediatric Coding Alert

Question: Our doctor ordered a voiding cystourethrogram (VCUG) for a 2-year-old female who has recurrent urinary tract infections (UTIs). The procedure, which our local hospital will perform, requires prior catheterization. Because of the child's age, the hospital requests that we perform the catheterization at our clinic before sending the patient to the hospital for the procedure. How should I code for the pediatrician's part?

Oregon Subscriber

Answer: Although some may question the benefit of upsetting the child twice by dividing this procedure, the hospital specialist, who is probably unfamiliar with the child, may think your pediatrician can perform the painful catheterization with the least amount of stress to the patient. Because of this legitimate concern for the child's welfare, you will have to understand how physicians usually perform the procedures.

Usually the pediatrician places the catheter in the morning, and the child goes directly to the hospital for the study. Because the catheter will remain in the patient until the study, you should report a temporary catheter placement with 51702 (Insertion of temporary indwelling bladder catheter; simple [e.g., Foley]). If the pediatrician has a problem while placing the catheter, such as the presence of a stricture or other anomaly, you should report 51703 ( complicated [e.g., altered anatomy, fractured catheter/balloon]).

So, assuming your pediatrician performed a scheduled catheterization with no other services, you should report 51702-51703 linked to the diagnosis for special screenings for neoplasms, such as V76.9 (Special screening for malignant neoplasms, unspecified).