Urology Coding Alert

There is some confusion about the correct way to bill for catheterization. Many coders believe that 53670* (catheterization, urethra; simple) is for catheterization in the hospital, and that G0002 (office procedure, insertion of temporary indwelling catheter, Foley type [separate procedure]) is for office use. Coders used to think that Medicare created G0002 because they didnt want to pay for 53670 in the office, says Stella Natarova, CPC, CCS-P, director of compliance and reimbursement for Adult and Pediatric Urology Group of Maryland in Baltimore. They thought in the hospital you should bill 53670, and in the office you should bill G0002. But thats not accurate.

There are actually three codes involved here: 53670, G0002, and P9612 (catheterization for collection of specimen, single patient, all places of service). The codes should be used the following way, explains Natarova: CPT code 53670 and P9612 are for a straight catheterization, such as is required for a sterile urine catch or whenever you have to obtain urine through a catheter, she says. The difference between 53670 and P9612 is the payer. If you need a clean catch specimen for testing, and insert a catheter to obtain it, you would code 53670 for a private payer, and P9612 for Medicare.

Effective Jan. 1, 1999, HCPCS code P9612 is used to report clean catch specimen collections in the physicians office for Medicare patients, says Sandy Page, CPC, CCS-P, co-owner of Medical Practice Support Services in Denver.

But if the patient cannot urinate and is in retention, and you need to insert a catheter to solve the problem on a temporary basis, you would bill G0002. If the patient is going to go home with the catheter in, you
bill G0002, says Natarova. Its based on the intent of the catheterization.

Put simply, G0002 is for a temporary Foley catheter, and P9612 is for a specimen collection.

Of all three codesG0002, P9612, and 53670G0002 pays the most, says Ray Painter, MD, a urologist who is president of PRS, a coding and reimbursement consulting firm based in Denver. The G-code was added to pay for the Foley catheter, Painter explains. Thats why it can only be used in the office. It gives you an extra $18 or so. The P-code was added so that Medicare could pay much less for catheterization that was only for a clean catch specimen.

One of the reasons the original confusion exists is that according to the Medicare fee schedule, 53670 is payable in the office and in the hospital, and G0002 is only payable in the office. That is because a catheter inserted in the hospital to help the patient urinate would be done by the hospital nursing staff. If you code a 53670 in the hospital, the physicians documentation must clearly indicate that he or she personally performed the catheterization, says Page.

Depending on the situation, an office visit can sometimes be billed and a different diagnosis is not necessarily required, says Page. If the primary reason for the visit is for a previously scheduled procedure, an evaluation and management (E/M) service should not be routinely billed. When billing 53670 or G0002 and a visit, modifier -25 (significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service) must be attached to the E/M code. However, since P9612 is not paid through the physicians fee schedule, but rather from the clinical lab fee schedule, an office visit may be reported and modifier -25 would not be required, says Page.