Urology Coding Alert

Question: I need help to clarify when to use HCPCS P9612 versus CPT 51701 for Medicare patients. I read an article that said when we see a Medicare patient for a straight catheterization for residual urine we have to bill P9612, but if the patient is not a Medicare patient we can bill for 51701. It makes no sense to me because P9612 only pays $3 and 51701 pays around $45-$100. Can you explain?

Florida Subscriber

Answer: For Medicare, you should use HCPCS code P9612 (Catheterization for collection of specimen, single patient, all places of service) when the urologist performs straight catheterizing for a clean urine specimen for urinalysis or culture and sensitivity.

Private payer difference: For non-Medicare patients you should use code 51701 (Insertion of non-indwelling bladder catheter [e.g., straight catheterization for residual urine]) for the same catheterization procedure.

Heres why: Medicare will not reimburse the higher fee for a simple catheterization to obtain a urine specimen. Remember you should use P9612 only for Medicare patients.

The silver lining: You can, and should, use 51701 for both Medicare and commercial/private carriers for a catheterized post voiding residual urine determination (PVR).