Urology Coding Alert

Question: What's the correct code for a nurse teaching a patient to perform self-catheterization? Is this considered part of the E/M service?

Montana Subscriber

Answer: In the office, a nurse teaching a patient self-catheterization can only use 99211 (Office or other outpatient visit for the E/M of an established patient, that may not require the presence of a physician. Usually, the presenting problem[s] are minimal. Typically, five minutes are spent performing or supervising these services), no matter how much time is involved. This should be billed as an incident-to service with the urologist present in the office suite. When the physician instructs the patient, bill according to the time spent, using an E/M code (99212-99215).

If, during the instruction by the nurse, the nurse performs a catheterization in addition to 99211, also report  51701 (Insertion of non-indwelling bladder catheter [e.g., straight catheterization for residual urine]) and 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 99211. Again, for payment this must be done on an incident-to basis, with the physician in the office suite.
For more information, see "News You Can Use: Medicare Clarifies CMS-1500 Form Rules".