toria11
Guru
Several of my physicians request to bill 51040 for a similar procedure as described below. Most of the time, a needle is used to guide the catheter into the bladder through the abdomen. They do perform this under general anesthesia in the OR. I've read that 51040 involves an incision through fascia, muscle, and then the bladder so I'm wondering if I need to bill 51102 instead? 51102 doesn't seem extensive enough and 51040 seems too extensive. Your help is appreciated!
DETAILS OF PROCEDURE: This gentleman presented to us with an aid. His
penis was quite sore. The urethral meatus was beginning to flay opened secondary to chronic Foley
catheter wear. He has been wearing this for about 14 months. His Parkinson's disease has been
advancing significantly. We talked about our options. We felt that it was reasonable to try the
above-mentioned procedure. So, he was given appropriate preoperative antibiotics in the holding area,
was taken to the operating room, and given a general anesthetic. A timeout was taken for identification
purposes. He was then placed in the dorsal lithotomy position, prepped and draped in a sterile fashion, and
a cystoscope was advanced on into his bladder and then the bladder was distended and in the midline.
With the scope up against the abdominal wall, we could visualize light through the gentleman's abdominal
wall tissue through the center of which and then we placed localizing 22-gauge needle. It seemed to be an
appropriate placement advancing on into the bladder, so next to this, we placed an 18-gauge Rusch
suprapubic punch. This was advanced without difficulty. The trocar was removed, and through the
center of that a 16-French Foley catheter was advanced and inflated to 10 cc and the bulb of the balloon
pulled up against the anterior bladder wall. The catheter was then stitched into place on the skin. He
tolerated the procedure well and was returned to the recovery room in stable condition.
DETAILS OF PROCEDURE: This gentleman presented to us with an aid. His
penis was quite sore. The urethral meatus was beginning to flay opened secondary to chronic Foley
catheter wear. He has been wearing this for about 14 months. His Parkinson's disease has been
advancing significantly. We talked about our options. We felt that it was reasonable to try the
above-mentioned procedure. So, he was given appropriate preoperative antibiotics in the holding area,
was taken to the operating room, and given a general anesthetic. A timeout was taken for identification
purposes. He was then placed in the dorsal lithotomy position, prepped and draped in a sterile fashion, and
a cystoscope was advanced on into his bladder and then the bladder was distended and in the midline.
With the scope up against the abdominal wall, we could visualize light through the gentleman's abdominal
wall tissue through the center of which and then we placed localizing 22-gauge needle. It seemed to be an
appropriate placement advancing on into the bladder, so next to this, we placed an 18-gauge Rusch
suprapubic punch. This was advanced without difficulty. The trocar was removed, and through the
center of that a 16-French Foley catheter was advanced and inflated to 10 cc and the bulb of the balloon
pulled up against the anterior bladder wall. The catheter was then stitched into place on the skin. He
tolerated the procedure well and was returned to the recovery room in stable condition.