Urology Coding Alert

Turning to 51700 isn’t always the correct tactic.

Coding for bladder voiding or irrigation is common enough, but sometimes even experienced coders can benefit from refreshers on everyday procedures. Kick start the new year with these five Q&As about such clinical scenarios, answered by Michael A. Ferragamo, MD, FACS,  clinical assistant professor of urology at the State University of New York at Stony Brook.

1. Voiding When Catheter Is Already In Place

Question: Patients sometimes come into our office for a voiding trial when they already have an indwelling urinary catheter in place. The nurse does a fill and then removes the catheter. Then we have the patient void. Can we bill 51700 for this even though the catheter was already in place? If so, do we need to include any modifiers on the claim?

Answer: Yes, you can report 51700 (Bladder irrigation, simple, lavage and/or instillation) fora voiding trial under these circumstances. The definition for code 51700 does not mention catheter insertion, which means you can report the code even if a catheter is already in place. CPT^® also instructs you to not report 51701-51702 when catheter insertion is an inclusive component of another procedure. Therefore, you can bill for the bladder filling whether a catheter was inserted at the time of the filling or whether the procedure is completed via a previously placed catheter. No modifiers are necessary.

2: Choosing the Best Code for BCG Instillation

Question: The coders in our office are at odds because we disagree about which CPT^® code to use for BCG (Bacille Calmette-Guerin) bladder instillation due to the descriptor wording for 51720 (Bladder instillation of anticarcinogenic agent [including retention time]). Our patients leave the facility immediately after the instillation. Should we use 51700 when the patient does not remain or void post-instillation in the facility?

Answer: Your co-workers are not alone: There can sometimes be confusion about the correct use of 51720 in the situation you describe because of the phrase “including retention time.” Even if the patient voids at home, however, reporting 51720 is still correct. Submitting 51700 instead is not an accurate assessment of what occurred, so is not a valid option.

3: Reporting Irrigation with a Cystoscopic Examination

Question:  How do I report the procedure when our provider completes a bladder irrigation through a supra pubic tube for multiple obstructing clots?

Answer: You should report 51700 for this procedure. If your urologist performed a cystoscopic examination in addition to the bladder irrigation, you should report 52001 (Cystourethroscopy with irrigation and evacuation of multiple obstructing clots).

Use ICD-10 diagnostic code N32.89 (Other specified disorders of bladder) for the urinary clot retention along with R31.0 (Gross hematuria) for the hematuria.

4: Selecting Your ‘Cocktail’ Code

Question: What code should I report when the urologist administers a “Whitmore cocktail”?

Answer: A Whitmore “cocktail” administration is a bladder instillation that consists of several non-chemotherapeutic drugs to locally treat patients with interstitial cystitis. You should report 51700 for the instillation.

Note: You report chemotherapeutic agent instillations, such as BCG and Mutamycin, differently. When reporting these treatments, you should submit code 51720 (Bladder instillation of anticarcinogenic agent [including retention time]).

5: Including Code for Heparin Solution

Question: A patient was placed in the dorsolitotomy position. After cleansing with betadine swabs, the patient was catheterized with a straight catheter. A solution consisting of 4 cc Heparin (10,000 units/cc), 5 cc lidocaine 1%, 10 cc sodium bicarb, and 5 cc Marcaine was instilled into the bladder. The patient tolerated the procedure well and was instructed to leave the solution in his bladder for 1/2 hour to 2 hours before urinating. How should we code for the procedure and the heparin solution?

Answer: You should file 51700 for the procedure and J1644 (Injection, heparin sodium, per 1000 units) for the injection.

Take note: Medicare and some PPOs will allow you to bill for heparin instillation; however, if the patient has an HMO, the plan often requires that you order the medication from the insurance carrier’s specialty pharmacy, and the carrier will supply the drug to you free of charge. In that situation you can only bill for the instillation and not the drug.