Reason for difficult Foley insertion must be given

May 1, 2005

My question concerns a difficult Foley insertion. If the physician wants to charge for the complicated insertion (51703), shouldn't the reason why it was complicated be documented?

Q. My question concerns a difficult Foley insertion. If the physician wants to charge for the complicated insertion (51703), shouldn't the reason why it was complicated be documented? I would think that just because the nurse could not perform the insertion and a physician had to be called in would not be enough to warrant the complication. If the reason was documented (eg, small urethra requiring dilation, stricture from previous prostate surgery, etc.), then the complicated CPT could be used. How much needs to be documented?

However, the physician is being paid for a procedure, not a diagnosis. The proper documentation to support the "complicated" catheter insertion should include the type of difficulty the doctor had. The use of the special catheter, peritoneal manipulations, use of the catheter guide, etc., are a few suggestions. Documentation that the nurse could not insert catheter and the physician "inserted catheter without difficulty" does not warrant the use of the complicated catheter insertion code.

A. The procreative management codes are probably your best bet. However, the V.26.21 specifically states that it is for infertility testing. Use that one for the testing involved only.

However, for the storage you're probably better off using the 26.9, procreative management, unspecified. I chose that one over the 26.8, procreative management, other specified, because I could not find a specific code for the procedures that you are charging for.

Q. In the February Urology Times, you wrote that G0353 could not be charged with an office visit on the same day. If a physician sees a new patient and decides on an injection of antibiotics, does this mean there can be no office visit charge? Also, can a certified registered nurse practitioner participate and bill G codes for administering chemotherapy intravenously?

A. For your first question, please see the correction above. Yes, you can charge an office visit on the same day as an injection if the visit qualifies for -25 modifiers, which should be added to the E&M code.

Yes, the CRNP can administer and charge for their services. These services can be charged by the physician under the "incident to" rules if the physician is immediately available. The charges can be made for the G codes requesting information about nausea, pain, etc. if the physician or other qualified Medicare provider is giving an intravenous fusion of chemotherapy.

Q. If a leuprolide injection is given on a different day than a chemo injection, can they both be charged?

A. Yes. All injections are classified as "0" global and therefore do not affect payment for any services delivered the following day. Actually, you could charge for both if given on the same day. Injection codes are not bundled.

Q. Should we be billing for a material tray with our prostate biopsies?

A. For Medicare, the answer is simple and clear: No. The non-facility fee, which is the payment you will receive for an office procedure, has an increased payment over the "facility" fee you are paid if this procedure were to be performed in the hospital or an ambulatory surgical center. That extra amount of money is calculated to pay you for the needles, other supplies, office space, and office personnel. It would be inappropriate to charge separately for any of those items.