Pediatric Coding Alert

Question: A father brought in his child who's had a fever of 102 degrees for several days. After evaluating the problem, the physician inserted a catheter to obtain a urine specimen. Insurance denied our claim with 51701. Should we have reported a different code?

Missouri Subscriber

Answer: Code 51701 (Insertion of non-indwelling bladder catheter [e.g., straight catheterization for residual urine]) should be acceptable, so double check the diagnosis you submitted. Also include an E/M code from 99211-99215 (Office or other outpatient visit for the evaluation and management of an established patient ...).

Diagnosis choice: Report 780.60 (Fever, unspecified) or 599.0 (Urinary tract infection, site not specified) if the physician diagnoses a urinary tract infection.

If the payer still rejects the claim, resubmit and append modifier 25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) to the E/M code.