Insights on The CPT Coding For Bladder Catheters

While doing a suprapubic insertion, use the code 51040 for a suprapubic open cystotomy with drainage. Now, there are many confusion concerning the use of a cystotomy with a Lowsley retractor (that is Lowsley retractors placed per urethra). It's depressed so that the blades of the Lowsley retractor which are closed are felt through the abdominal wall through the bladder. And what the urologist does when he feels this Lowsley retractor in the dome of the bladder, he make an incision through the skin, the subcu, the anterior rectus fascia, the muscles, the perivesical fascia and makes an incision in the bladder itself. This is a cystotomy, although it may be smaller than the standard, it is a cystotomy so you would also use in this case the 51040. Now, I've also included the code 51045 which is an open cystotomy in which you then place urethral catheters or stents from above through the urethral orifice under direct vision. This is a separate procedure.

When you talk about bladder aspiration codes, we do have a code 51100 where you aspirate or drain the bladder by a needle place suprapubicly into the distended urinary bladder. You can also do that using a trocar or an intracath, a little larger instrument than the above, and that code is 51101. Most often the urologist will do an aspiration of the bladder with the insertion of a suprapubic catheter. He'll make a small incision in the skin, possibly the subcu, and then pass a trocar into the bladder puncture also called a puncture cystotomy. And this would then drain the bladder. And through the trocar, he would pass a catheter and he would have - this was called a trocar or punch cystostomy.
Now, for image guidance for these procedures, many times one may use ultrasound to visualize the bladder, 76942 and occasionally, a CT 77012 or an MRI 77022. The codes 51100 and 51101 have a zero day global.

When we're talking trocar cystotomy, the 51102 is the aspiration of the bladder with the insertion of a suprapubic tube. Notice how the payments for this service have changed between 2008 and 2009. If you did a trocar or punch cystostomy in the office in 2008, you were paid $354.21. You are paid in 2009 significantly less, less 32%. You do this in a hospital in 2008, you were paid $263.56. If you do the same procedure in the hospital in 2009, you would be paid $157.25. And these are the 2009 unadjusted standard Medicare fee. Now, that is a reduction of 40%. Now, it's important to remember that there was a change in 2009 with the revision of the CPT code 51102. And the revision was that the global period which in 2008 had been ten days was changed to zero days in 2009. That means that you should bill and you will be paid for all postoperative care that you administer after doing a suprapubic trocar cystostomy.

Now we're going to talk about the change of the catheters and removal of suprapubic cystotomy catheters. We have a code 51705 and that's the change of a suprapubic cystostomy tube simple. You take out the catheter and empty the balloon if there is a balloon-type of catheter. Take the cath, slip the catheter out and slip another one in and blow up the balloon. Usually the diagnosis for this change of the catheter is the same as the previous reason for placing the initial cystotomy tube, most often urinary retention 788.20 or bladder atrophy such as 596.4 or paralysis of the bladder 596.53.
Now, we do have a code, 51710, which is change of the cystotomy tube. And this is complicated, meaning once you take out the catheter, you have trouble getting a catheter back in. And you might have to dilate the stoma because you have a stomal stenosis of the cystotomy opening, ICD-9 code 997.5 or you have to replace the catheter over a guide wire or you have to use a catheter guide to get the catheter back into the bladder.

Now, if you just remove a cystotomy tube and leave it out and do not exchange it, there is no special CPT code for the simple removal of a cystotomy tube. Otherwise, this procedure of simple removal falls under the guidance of an E/M service. Now, I've also included for you the open surgical closure of a cystostomy which is CPT code 51880. This code, 51880, is also used for the closure of a vesicocutaneous fistula. Use the same code, 51880, for the closure of a vesico-bladder cutaneous skin fistula communication. Let's go to the next slide and let's look at some CMS coding changes for urethral catheters and stents. Now, code 52332 after April 1st, 2007 was no longer bundled into the 52320 cystourethroscopy and removal of the urethral stone or 52330 cystourethroscopy and manipulation of the stone without removal. And it was no longer bundled into the 52341 cysto and treatment of urethral strictures. And it was no longer bundled into ureteroscopy codes and procedures up to 52354. So modifier -59 is not required when you bill the 52332 with the above code. That was from April 1st, 2007.