Urology Coding Alert

Question: A patient was placed in the dorsolitotomy position. After cleansing with betadine swabs, the patient was catheterized with a straight cath. 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 one code for the procedure and the heparin solution?

Nevada Subscriber

Answer: You will file 51700 (Bladder irrigation, simple, lavage and/or instillation) for the procedure and J1644 (Injection, heparin sodium, per 1000 units) for the injection.

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.