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Follow these tips to properly report bladder catheter codes

APCs Insider, September 1, 2006

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Follow these tips to properly report bladder catheter codes

QUESTION: If a staff member places a Foley catheter, but removes it before the patient leaves the ED, which code should we report-51701 or 51702? I thought that 51702 should be used if the patient left with the catheter still in place, which would be indwelling. I also believed that 51701 would be used if the patient's catheter was removed prior to leaving, no matter what kind of catheter was used (Foley, etc.). As a note, both catheters are used for urinary retention or post-void residual.

ANSWER: Here are the descriptors and APC assignments for the two codes:

• 51701, Insertion of non-indwelling bladder catheter (e.g., straight catheterization for residual urine). APC 00340, status indicator X.
• 51702, Insertion of temporary indwelling bladder catheter; simple (e.g., Foley). APC 00340, status indicator X.

An indwelling bladder catheter has a balloon to hold it in place, which allows it to remain inserted for a period of time. A straight catheter does not have a balloon and is generally used to check for residual urine, or to relieve acute urinary retention, and is then immediately removed. There is no way to keep a straight catheter in place because urine would leak around it.

When the catheter is left in place for a short period and then discontinued before the patient leaves the hospital, it is likely a temporary indwelling bladder catheter. The term "Foley" is usually used in relationship to an indwelling catheter with a retaining balloon.

The confusion arises when someone uses an indwelling catheter to perform a simple in/out procedure. Because the straight catheters can be cheaper than the Foley or indwelling catheters, the staff person does not do the patient a favor if they do this, but an indwelling catheter could be used like a straight catheter.

For coding purposes don't look at the type of catheter used. Instead, look at the reason for the catheter and whether the catheter was retained for a period of time after being inserted. If the doctor orders a residual urine check, the catheter is inserted, the bladder drained, and the catheter removed, report 51701. Anytime the procedure is a basic "in/out" procedure, report 51701. Use 51702 if the patient comes in for any reason that requires temporary drainage of the bladder for treatment or monitoring purposes, the catheter is inserted, the balloon inflated, and the catheter is left in place until the patient is later discharged.

Note: If the patient presents to the ED for replacement of a Foley catheter, report 51702. Also note that if a straight catheter is used for urine collection for a lab test, do not report 51701. Report P9612 (Catheterization for collection of specimen, single patient, all places of service), which will be paid under the lab fee schedule beginning in 2007.

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