Urology Coding Alert

Question: A general surgeon asked our urologist to insert ureteral catheters for easier identification of the patient’s ureters during pelvic abscess surgery. I’m not sure of the correct diagnosis since the urologist says the catheters were only used for identification of the ureters. Medicaid denied our claim with 52005 and diagnosis K65.1 for being inconsistent with the procedure. What do you recommend?

Pennsylvania Subscriber

Answer: The primary surgeon performing the procedure for pelvic abscess would report diagnosis K65.1 (Peritoneal abscess). The urologist only inserted the catheters for identification purposes, so a better choice for your physician would be Z40.8 (Encounter for other prophylactic surgery). Pull whatever details you can from the operative report and medical record to explain what the urologist did and why. A note from the general surgeon detailing his reasons for wanting the catheters inserted would help support your physician’s claim.