Use the complicated catheterization code when you have to pass a catheter over a guide wire. When - to insert the catheter, you must use a catheter guide. If you use a special type of equipment to get the catheter in such as a council tip catheter or you cannot pass a Foley and you go to a Coude catheter which passes, use the code 51703. If you have to try several catheters, maybe you start with an 18 French. If catheter does not pass, use a16 French, the catheter does not pass, but then you get in a 14 French catheter. For those multiple catheter usages use code 51703. If you can't get a catheter in and you inject and instil a lubricant or a jelly into the urethra and then pass the catheter, you should bill the code 51703.
Also, anytime you cannot get a catheter out, for whatever the reason, and you have to cut the inflation limb and then pass a wire down the inflation limb of the catheter to break the bulb or you use a needle to puncture the balloon either suprapubicly or perineally, with or without replacing the catheter, use the code 51703.
Now, the diagnosis to use this 51703 should be the following – 598.9 urethral stricture, 599.4 urethral false passage, 596.0 bladder neck obstruction, 99631 a mechanical problem with a urethral catheter. And then you may want to use the secondary code, the V53.6, indicating that you are fitting or applying or adjusting for a urinary catheter. Now, if we look at the HCPCS code for 2009, code P9612 is for catheterization of the bladder for collection of a specimen such as clean urine for urine analysis or for culture and sensitivity. This is preformed in a single patient. It could be in all places of service. But remember that this code is only used for the Medicare insurance and payment is $3.
And this is another clinical scenario using an EOB from Medicare. Here, we have an established patient visit, the 99213, and we then have catherized urine for a UA or screening culture specimen. And we bill that with P9612. We also did a urine analysis, 81002. And we also did a screening culture which for Medicare is 87081 paying $9.26.
Let’s look at another catheterization of the bladder for urine. And this is for EOB from a private carrier. Here, we're doing a urine screening culture. And for this carrier, they want the code 87070 for the screening culture. And since this is not Medicare but it's a private carrier or an HMO, we used the code for catheterization, not the P9612 code, which as we stated is only for Medicare usage. But we used the catheterization code, the catheter put in, drain the urine and take the catheter out for private carriers. And as you can see, they paid us $70.56.
It's important to remember that these codes are bundled into each other and there is no way you can unbundle them with any modifier. So in general, in principle, when you're billing these codes, you should only bill one code. On occasion, a urologist will put in a Foley catheter, billing 51702. And during the drainage of the urine, he takes a urine specimen for a culture in a Medicare individual patient. And he also would then bill the P9612.
When this happens, the Medicare carrier will not pay for both, but will pay for only one. They will pay for the P9612 for $3 rather than the 51702 for a $70 charge.
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