Urology Coding Alert

Question: Should I use the same technique for coding catheterization of a conduit for a specimen for both Medicare and private carriers?

South Carolina Subscriber

Answer: When coding a conduit catheterization with a straight catheter, many urology coders don't realize that their approach should vary depending on the patient's carrier.

For a Medicare patient, you should use HCPCS code P9612 (Catheterization for collection of specimen, single patient, all places of service) for the catheterization. If the physician provided and documented an E/M service, you should also code the E/M service, 99201-99215. Modifier -25 (Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service) is not necessary with P9612 because it is listed under laboratory services.

For a patient with a private carrier or HMO, the catheterization may be included in the low-level E/M service and should not be billed separately. Only the low-level office visit should be reported if the catheterization constitutes the entire encounter. The AUA recommends the use of 53670* (Catheterization, urethra; simple) for catheterization for specimen collection.

Answers to You Be the Coder and Reader Questions contributed by Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology, State University of New York, Stony Brook; and Morgan Hause, CCS, CCS-P, privacy and compliance officer for Urology of Indiana LLC, a 19-urologist practice in Indianapolis.