Urology Coding Alert

Question: We have a patient with a chronic catheter. He brought his own supplies, and the nurse changed the catheter. Should we charge CPT 99211 or can we charge 51702?

Pennsylvania Subscriber

Answer: Many carriers will reimburse for both codes, under the right circumstances. If the nurse does a significant service, you can bill for both 99211 (Office or other outpatient visit for the evaluation and management of an established patient that may not require the presence of a physician) and 51702 (Insertion of temporary indwelling bladder catheter; simple [e.g., Foley]).

Requirements: To be considered significant, the service the nurse provides should include examining the patient and determining whether the catheter should be removed and replaced. The nurse should also check that there are no complicating factors - such as a urethritis, abdominal tenderness or an epididymitis - that would require further urological evaluation.

If you report both codes, be sure to 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 indicate that the E/M service the nurse provided was indeed significant.

Remember: These services should be within your state's scope of practice for the nurse, and the urologist should also be within the office suite when the services are performed.