Failed Foley insertion

Friday,
November 21, 2003
Vol. 4, No. 46

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QUESTION: For a patient seen in the ED, the documentation states "two failed attempts to insert Foley catheter by nurse, and no success with doctor attempt." The patient was then admitted. Should the failed attempt be coded as 51702-52 for the supply charge for the Foley material?

ANSWER: For a failed attempt to insert an indwelling Foley catheter, use CPT code 51702 with modifier -52. The OPPS rules state that modifier -52 may be used when significant use of facility resources/supplies is documented. CMS has not assigned an APC to 51702, but it may be reported. If the patient is admitted to the hospital, as noted above, no ED services will be paid separately but rather rolled into the diagnosis-related group (DRG) for the inpatient stay (excluding situations in which costs may be reported for outlier payments).

For an unsuccessful attempt followed by a successful catheter insertion, use code 51703 "complicated catheter insertion." The CCI edits list 51702 as a component code of 51703. You cannot override this edit (modifier indicator status 0). The OCE editor shows edit 27 "only incidental service reported" because the OPPS does not have an APC for either code. Remember to code for your ED visit in addition to the attempted Foley insertion.

However, if the reason for the Foley insertion is to obtain a urine sample for diagnostic testing, assign HCPCS code P9612 for reporting catheterization for specimen collection.

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Questions from readers are answered by a team of experts working in the APC area within the health care industry. Their answers are provided as advice. Readers should consult the federal regulations governing OPPS, related CMS sources, and with their local fiscal intermediary before making any decisions regarding the application of OPPS to their particular situations.

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