Urology Coding Alert

Question: My urologist did a suprapubic tube change (51705). He had heard at a seminar that he can charge for irrigation of debris (51700) if he does this prior to the SP tube change. But 51705 and 51700 are bundled by NCCI, with a "0" modifier indicator - which means we can't report them separately. Is irrigating the debris really included in the SP change service? Is there any way we can get paid for both the irrigation and changing the SP tube? Are there other codes we should consider?

Michigan Subscriber

Answer: The change of a simple suprapubic tube - 51705 (Change of cystostomy tube; simple) - includes any irrigation - 51700 (Bladder irrigation, simple, lavage and/or instillation) - that you may perform. You are correct: Modifier indicator "0"means that you cannot override this Ncci Edits bundling edit with any modifier, which means you can't report those two CPT Codes together.

Bright side: The complicated changing of a suprapubic tube - CPT 51710 (Change of cystostomy tube; complicated) - does not bundle 51700. NCCI does not consider irrigation an integral part of a complicated SP tube change.

Therefore, if the urologist performs a complicated change of the suprapubic tube (dilating the tract before inserting the tube), and then irrigates the tube because of bleeding, use 51710 for the complicated change of the suprapubic tube and 51700 for the irrigation of the tube, possibly for removal of blood clots from bleeding following the dilation of the suprapubic tract.