Health Information Management

Q/A: Coding 'in and out' bladder catherizations

APCs Insider, December 11, 2009

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Q: Can we code bladder catheterizations when a urine specimen is obtained for an analysis and the catheter is “in and out?”
A: Reimbursement policies may vary by payer, but Medicare instructs providers to report HCPCS code P9612 for catheterization for collection of specimen, single patient, all places of service. Report this code when a clinician obtains the specimen with a straight catheter. This HCPCS code requires revenue code 0300 Laboratory and the Medicare laboratory fee schedule determines the payment amount. Ensure that a physician order is evident along with appropriate documentation to uphold revenue received.
CPT code 51701 (insertion of nondwelling bladder catheter [e.g., straight catheterization for residual urine]) is a specific procedure, again requiring a physician order. It describes the insertion of a nondwelling bladder catheter used for intermittent catheterization or catheterization to obtain remaining postvoid residual urine and then the catheter is removed. If procedures denoted by 51701 and P9612 are both performed on a patient during the same day, they trigger a CCI edit because P9612 (Column 2) is a component of 51701 (Column 1) and P9612 cannot be reported separately. This edit is not subject to a modifier, therefore even if the procedures were performed in separate encounters, P2612 cannot be reported separately.
Refer to Coding Clinic for HCPCS, vol 7, no.3, third quarter 2007, and CPT Assistant, October 2003 and January 2007 for more information.

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