When we put a catheter in, drain the bladder and take a catheter out— as we do for a straight catheterization and for a post-voiding residual determination— we should use the code 51701. Notice the 2009 unadjusted or standard Medicare fee schedule. Now when we talk about and adjusted, mean that this fee is unadjusted for the state or the area in the state in which you practice. But note that we are paid - when we do this in the office, we're paid $61.67. And when we do it in the hospital, the straight catheterization in and out, we're paid $28.13.
Now the increased pay in the office is due to the expense of doing this in the office and the expense of providing the catheter for the drainage. Code 51702 is the insertion of a temporary indwelling bladder catheter. Anytime you put a Foley catheter and leave it in, you should bill the 51702. Note that the payment in the office, the unadjusted fee is $79.35, significantly more than what you're paid by doing that in the hospital, $31.02. The $79.35 includes your expenses, including your provision, providing the patient with a catheter, probably also a leg bag and other tubings for urology drainage.
What is an EOB? An EOB is an explanation of the billing and how we were paid from medic - and this is from Medicare. Notice that we bill a 99213, an established office, with modifier -25 because we're also placing a catheter 51702. When you deal with Medicare using modifier -25 on the E/M code and do another procedure at the same time – for e.g. the placement of the Foley catheter, the 51702 for Medicare, we can use the same diagnosis. And notice that the diagnosis that we use was BPH with obstruction and/or low urinary tract symptoms for both the E/M service and for the insertion of the Foley.
Most of the time the private carriers, non-Medicare carriers such as HMOs who do not like to pay you for both services, will pay you often if you give them separate diagnosis for the E/M visit and for insertion of the Foley. And in this case, for our established office visit, we bill the code 600.01 BPH with obstruction and/or low urinary tract symptoms. And the diagnostic code for the insertion of the Foley catheter, the 51702, we bill with the code 788.20 urinary retention. Note that we paid for both the E/M services, the 99213 and the 51702, the insertion of a temporary indwelling Foley catheter.
Suppose we have code 51703. Now, this code should - is probably not used as often as it should, but this represents complicated ureteral catheterization or the passage of a Foley in the patient in which you have some problem and difficulty in getting the catheter in, most often secondary to (organ) anatomy which we'll speak about in a moment.
You can also use this code if you have trouble getting a catheter out with a fractured catheter or balloon when you require other special items for the catheterization. Again note that the unadjusted Medicare fee for the office is $143.18 as opposed to what we are pay when we do this service in the hospital, $84.76. The $143.18 includes our expenses in the office which include the provision of the catheter and other special items for the catheterization.