Urology Coding Alert

Urology coders get confused about coding for catheterization because there are four possible codes 53670* (catheterization, urethra; simple), 53675 (catheterization, urethra; complicated [may include difficult removal of balloon catheter]), P9612 (catheterization for collection of specimen, single patient, all places of service) and G0002 (office procedure, insertion of temporary indwelling catheter, Foley type [separate procedure]).

Avoid denials by choosing the code based on the reason for the procedure (specimen collection or retention), the place (hospital or office) and the payer (Medicare or commercial).

Coding Specimen Collection as the Reason

Urologists sometimes catheterize a patient to obtain a clean-catch urine sample one that is not contaminated by the skin. We do this if the patient had a urinary tract infection or cystitis, explains Kathy West, biller for Shore Urology in Long Branch, N.J. The urologist must test the urine for bacteria to see if the antibiotic treatment cleared up the infection, for example, and any bacteria on the skin would give a false reading. The catheter is inserted to get the specimen, and then removed. A nurse or a urology technician often performs this service.

For specimen collection on a Medicare patient, report P9612. This code is for office and hospital use. Many urologists catheterize all female patients for a clean urine sample in the office. In this case, use P9612. Medicare pays about $3 for this service. Bill private payers for specimen collection, in the office or hospital, with 53670*. Most office catheterizations for specimen collection only require 53670*, West says, and not the complicated catheterization code (53675). Code 53670* can be used in addition to an office visit if there is a significant, separately identifiable reason for the office visit. Append modifier -25 (significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service) to the office visit in such a case.

For all patients, use 53675 for a complicated catheter placement requiring the use of a catheter stylette, insertion of a guide wire, or the use of a special catheter introducer, recommends Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology at the State University of New York, Stonybrook. Also, use 53675 if there is difficulty removing a catheter (the balloon must be broken, for example). Do not charge for the simple removal of a catheter. Code 53675 will reimburse more than 53670*.

Coding Retention as the Reason

Patients in retention require a temporary indwelling catheter that is different from the one used for specimen collection. It is more costly than the specimen collection catheter, and the patient goes home with the catheter indwelling, which remains in for less than three months.

For Medicare patients, catheterization done in the office for acute urinary retention should be billed using G0002. This code also gets reimbursement for the catheter. In many locales, reimbursement is over $100.

If you catheterize a patient to determine a residual urine or to empty the bladder and do not leave a catheter indwelling, code 53670*, Ferragamo says.

Catheterization of non-Medicare patients performed in the office to treat acute or chronic retention should be billed with 53670* or 53675 the same codes used to bill private payers for specimen collection in the office. Use 53670* when the urologist periodically (every four to six weeks) changes a permanent Foley in the office.

For all payers, catheterization done in the hospital to treat retention should be billed with 53670* or 53675. Urologists frequently perform this catheterization when they are called in for an inpatient consultation. The physician determines that the patient is in retention, and then performs the catheterization, West says. In this case, the urologist would bill a consultation code with modifier -25, and the catheterization code 53670*. Separate diagnoses may be needed for payment.

Note that in the hospital setting, the catheterization must be performed by the physician if you are coding for it. Document that the physician did the catheterization, or the payer will think the hospital nurse did it and deny your claim.

Because the reason for the catheterization is linked to the code you use, make sure you are using the correct diagnosis code. If you filed G0002 and use incontinence as the diagnosis code, Medicare will deny your claim.