What constitutes a catheter or a stent? When you place a temporary catheter or stent, these are usually ureteral catheters—whistle-tip catheter, an olive tip catheter and a (poly) catheter—and these are placed at surgery to assist during surgery, and they are removed after surgery before the patient leaves the OR. Now, with permanent which usually implies the use of a double J stent, meaning he's going to stay in a while. It's placed after surgery for drainage. It's indwelling and self-retaining. And the patient leaves the operating room with the stent in place to be removed at a later date. This fact of leaving and removing the stent at a later date should be stated clearly in your OR dictation and documentation.
When it comes to the placement of ureteral catheters and stents, the urologist is often asked by his gynecological or colorectal surgeon colleagues to place preoperative – and they mostly call them stents for ureteral identification when a complicated pelvic or abdominal procedure is anticipated. Now, when we place these stents, they are not really stents. They are ureteral catheters – whistle-tip, olive-tip, arrow-tip or (poly) type catheters. And when you bill them, you should bill the code 52005 for this procedure. Now, they are usually put up bilaterally. Now, for Medicare, you're going to bill the 52205. And for private carriers, you're going to bill the 52205 left - they often wanted it on two lines, 52205 RT. And many want the -50 modifier also added. Now, if we look at this second line, we see the numbered modifier always goes before a lettered modifier.
What ICD-9 coding is correct when we pass catheters up for identification, the 52005?
Well, the first thing the urologist should do is look at any studies that have recently been performed usually preoperatively and most often that's a CAT scan. And he should bill for the placement of the catheters if there is any abnormal for urological anatomy – 591 hydronephrosis, 593.3 ureteral angulation or kinking, 593.4 if there's retroperitoneal fibrosis compressing the ureter, 593.5 hydroureter or 593.89 if there appears to be compression of the ureter by periureteritis. Now, if that's not the case - in other words, the upper urinary tracts are normal, the AUA and CPT tells us that bill for this service the reason for the primary surgery. In other words, why the gynecologist or colorectal surgeon is operating. 562.10 to 562.13 diverticulitis/diverticulosis, 153.3 sigmoid carcinoma, 154.0 rectosigmoid carcinoma, 180.9 cancer of the uterine cervix, 182.0 cancer of the endometrium or 218.1 a mural leiomyoma.
Now, the problem is that we are billing a urological code, the 52005. And the computer at the carrier's level will not understand why we're doing a urology procedure for surgical diagnosis. And they may not pay for the 52005. If that happens, resubmit the claim using the ICD-9 diagnosis that we mentioned before, 591 as the primary and V07.8 as the secondary. What these codes tell the computer at the carrier's level that the procedure that you did, the 52005 was done prophylactically, secondary code V07.8 to avoid primary diagnostic code hydronephrosis 591.