Health Information Management

Q/A: Billing for services provided during observation

APCs Insider, April 9, 2010

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Q: For a patient in observation, a nurse provides CPT code 51702 (insertion of temporary indwelling bladder catheter; simple [e.g., Foley]) and 91105 (gastric intubation, and aspiration or lavage for treatment [e.g., for ingested poisons]). How should we code and charge for these procedures and the catheter and tube during observation?

A: Charging for the insertion of procedures such as CPT 51702 and 91105 depend on whether the procedure was performed as an integral part of another procedure.
 
Catheter insertions that are considered to be integral to another procedure are not separately payable and the costs are captured within the procedure APC payment. For example, a Foley catheter inserted pre or post surgical procedure would not be separately reportable.   
 
In addition, Medicare issued an important Q&A (#9974) on its Web site regarding how to report observation services during active monitoring (i.e. diagnostic and/or therapeutic procedures). We encourage all facilities and their revenue cycle committee to review The Medicare Claims Processing Manual (Pub 100-4), Chapter 6, Section 290.2.2 regarding observation services and active monitoring.

 



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