Health Information Management

Do not report 51701 with P9612 for specimen collection

APCs Insider, February 16, 2007

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Do not report 51701 with P9612 for specimen collection

QUESTION: When staff catheterize a patient for specimen collection only, can you report both 51701 (Insertion of non-indwelling bladder catheter) and P9612 (Catheterization for collection of specimen, single patient, all places of service)?

ANSWER: No. The Medicare Claims Processing Manual, Chapter 16, section 60 (Manual 100-04) states the following:

In addition to the amounts provided under the fee schedule, the Secretary shall provide for and establish a nominal fee to cover the appropriate costs of collecting the sample on which a clinical laboratory test was performed and for which payment is made with respect to samples collected in the same encounter. A specimen collection fee is allowed in circumstances such as drawing a blood sample through venipuncture (i.e. inserting into a vein a needle with syringe or vacutainer to draw the specimen) or collecting a urine sample by catheterization.

Note that the specimen collection fee associated with P9612 (status indicator A, paid under the lab fee schedule) involves a "nominal" amount of $3.00, whereas the 2007 national payment for 51701 (APC 0340, status indicator X) is $37.51. If staff perform the catheterization only for collection of a urine specimen, report P9612. If staff perform the catheterization for a diagnostic or therapeutic reason, such as checking for residual urine, and then remove the catheter, report 51701.

Frequently, staff may collect a urine specimen while performing the service associated with 51701. However, do not bill P9612 with 51701. According to current CCI edits, P9612 is a component of Column 1 code 51701, and you cannot bill them together using any modifier.

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