Urology Coding Alert

Question: A colorectal surgeon requested that our urologist insert a ureteral catheter during a colorectal procedure. The procedure was inpatient, but ureteral catheter placement is on our outpatient list. What is the correct way to handle this?

North Carolina Subscriber

Answer: Surgeons from other specialties often request that a urologist place a ureteral catheter prior to a procedure because they want to ensure that the ureter is protected during surgery. This is not an uncommon scenario for either inpatient or outpatient procedures and can be billed for either setting.

Payment for the catheter placement will depend on the reason supporting medical necessity.  Diagnoses that could be acceptable for billing include any urological pathology found, such as N13.39 (Other hydronephrosis) or N13.4 (Hydroureter). You’ll also have several potential choices for diagnoses assigned by the primary surgeons. These might include:

• K57.30-K57.33 (codes related to diverticulosis or diverticulitis of large intestine without perforation or abscess; some diagnoses designate bleeding and others do not)
• C18.7 (Malignant neoplasm of sigmoid colon)
• C19 (Malignant neoplasm of rectosigmoid junction)
• C54.1-C54.3 (Malignant neoplasm of endometrium, myometrium, or fundus uteri)
• Z40.8 (Encounter for other prophylactic surgery)
• N13.39 (Other hydronephrosis)

Catheter placement is not on Medicare’s list of predefined inpatient or outpatient procedures, so check your specific payer policy and the diagnoses so you can bill accordingly.