Pediatric Coding Alert

Question: We perform catheterizations for urine specimen collection in our office. We want to make sure we are using the correct codes. There doesnt seem to be a procedure code for catheterization/specimen collection, so we use 87081 and 87087. Is this appropriate?

Dana Adkison
Northwest Pediatrics

Answer: First, there is no CPT code for catheterization combined with specimen collection, but there is one for just catheterization. While this doesnt need to be done very often, when it does, you should use 53670 (catheterization, urethra; simple). In pediatrics, if you need a clean catch specimen, you usually must obtain it by catheterization (in adults, a clean catch specimen is usually provided by simply cleaning the area before urinating). You should be using 53670 for catheterization; it has a reimbursement rate of $37 to $44 according to HealthCare Consultants 1999 Physicians Fee & Coding Guide, and you can bill for the office visit and the urine test, as well.

Whether you should use the other two codes depends on whether you do the laboratory test yourself or send it out. Code 87081 is the correct code for doing a bacterial screening culture. Code 87087 is for using a commercial kit to do a quantitative colony count. If you have a lab in your office, you could be using these codes to test for urinary tract infections. Pediatricians who have office labs prefer to do the tests in the office because they get results much faster than if they send them out. However, if you do send them out, you cant use these codes. You could use the catheterization code for the collection, if you catheterize the child. But if you collect the urine by other means, the collection itself is included in the office visit.

Urine collection can present coding challenges for pediatric practices because there can be a great amount of time involved, even if you are not doing a clean catch. Most of the time, urine specimens for young children are brought in by the parents, who are sent home with a plastic bag to catch the urine in. No matter how much time it takes to convince a 4-year-old to go along with this, its the parents time, not your staffs. What if you collect urine in the office, with some kind of potty, and the nurse spends half an hour on the entire process? Unfortunately, there is no way to code for this staff time. Its included in the office-visit code. You cant raise the level of the code based on time spent, either, because the time is not based on counseling or coordination of care (and furthermore, the physicians time isnt even involved). So the answer to the question is, to use 53670* when catheterization is done, in addition to the E/M services code.

Note: Code 53670* is a starred procedure, which means that you can code for the E/M service as well.

If you are just doing the dipstick test, with no culture, you would use 81000 (urinalysis, by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific gravity, urobilinogen, any number of these constituents; non-automated, with microscopy) if you performed the test with microscopy, and 81002 without it.