Coding For Urethral Dilation and Uncomplicated Urethral Foley Passage


If you are coding for urethral dilation and a simple uncomplicated urethral Foley passage, remember that code 51701 and 51702 are bundled into the urethral dilation code 53600. And the urethral dilation code pays more than the 51701 and the 51702. So, if you do this procedure either in the office or the hospital, bill only the code 53600. Also know that if you dilate the patient with filiform and followers and then pass simply a Foley catheter without a problem. The urethral dilation with filiform and followers is code 53620. And again, the 51701 and the 51702 are bundled into the 53620. So, if you do dilation with the filiform and followers and then put in a catheter— whether you do this in the office or the hospital— bill the higher paying code, the 53620.

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Now we'll look at urethral dilation and the complicated Foley passage. When you do a urethral dilation in (squeak) sound, the 53600, remember that the 51703 is bundled into the 53600. And you can only bill one code. You cannot break the bundle. When you do this in the office, in other words, you do dilation with sounds and then put in a Foley catheter difficult placement, bill 51703 whether you do this in the office or the hospital. Now, code 51703 is bundled also into the 53620, which is the urethral dilation with filiform and followers. You cannot bill both. You bill either one or the other.
Now, when you do this in the office, bill the code 51703 because this pays more than the 53620. If you do it in the hospital however, bill the 53620, the urethral dilation with filiform and followers because that pays more than the 51703 when performed in the hospital. Your diagnosis for these cases should be urethral stricture, the codes 598.00 to 598.9.

For instance, we have a patient that is undergoing cystoscopy and urethral dilation. Now, when you do a cystoscopy and urethral dilation, this combination and in any sequence of cystoscopy and urethral dilation with or without the myotomy, with or without injection procedure cystography, either the male or the female, use the code 52281, cysto and urethral dilation, 52281. Remember though that this code also includes the placement of a catheter in and out, 51701, a Foley catheter indwelling, 51702 and a complicated catheterization, 51703. They are bundled in the 52281, which pays more than either one of those three.

There is no modifier that you can use to unbundle this association. Now, the diagnosis for using the 52281 as you would expect is urethral stricture 598.6, bladder neck obstruction 596.0, urethral fistula 599.1, 599.4 urethral false passage and 599.60 obstructive uropathy. In the payment in the EOB seen below, you will see that we billed a 99213 with modifier -25 and the 52282 and we were paid for both. Notice that we were paid significantly well for the 52281 paying $473 performed in the office in New York City.

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