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Topic: Learn the four catheterization codes, part two

Ambulatory Surgery Reimbursement Update, August 26, 2008

Last week’s ASRU looked at three of the four catheterization codes, including 51701 and 51702, the most commonly used, and HCPCS II code P9612. Coders should not use these codes together, says Michael A. Ferragamo, MD, FACS, assistant clinical professor of urology at the State University of New York at Stony Brook’s University Hospital in Garden City. Instead, they should look at the documentation to determine the appropriate single code to report. Here’s a closer look at the fourth code: 51703.

Ferragamo says that coders should review when it is appropriate to apply CPT code 51703 so they don’t miss any opportunities for reimbursement, since it is the highest paying of the four catheterization codes.

Report CPT code 51703 for complicated catheterizations, for example, when the urologist has trouble getting the catheter in. This could be due to a patient’s abnormal anatomy or perhaps a balloon that wouldn’t deflate properly.

You may also apply CPT code 51703 when the urologist has to resort to passing a catheter over a guide wire, using a catheter guide or a council tip catheter, or using a Coude catheter, Ferragamo says. Also, if the urologist has to use several different-sized catheters or has to inject lubricant into the urethra to get the catheter in, you can bill code 51703.

“It’s important to note that coders should use this complicated catheterization code only if the urologist has trouble getting it in,” Ferragamo says.

“Sometimes a nurse, intern, or physician’s assistant might have trouble getting it in, but you cannot use code 51703 in those cases,” he adds. Ensure that the documentation reflects that it was the urologist and not another staff member who had trouble placing the catheter.

When you use CPT code 51703, also use the following diagnosis codes to indicate medical necessity properly:

 

  • 598.9, urethral stricture
  • 599.4, false passage
  • 596.0, bladder neck contracture
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    Ferragamo says that coders may also apply CPT code 51703 if the urologist has trouble getting the catheter out and has to resort to cutting the inflation limb, breaking the valve, or using some other maneuver to remove the catheter successfully.

    For more information on catheter coding, see the August issue of Ambulatory Surgery Coding and Reimbursement Insider.