Wiki Bladder irrigation 51700

[Bernadette10]

Is this enough to bill 51700, or only 51702?

Indications: Urinary Retention s/p voiding trial yesterday

Procedure:
The patient was correctly identified. The Foley catheter site appeared clean. The site was prepped with betadine. A new 16 French Coude Foley catheter was inserted into the bladder without difficulty. Balloon inflated with 10 cc of sterile water. The bladder was drained for 525 ml dark yellow urine. The bladder was then irrigated with 60 cc of normal saline without difficulty. Catheter was secured and attached to a leg drainage bag. The patient tolerated the procedure well. There were no known complications.

 

[csperoni]

To me, there is sufficient documentation there for bladder irrigation 51700. The full description is below with my emphasis added to the sentence about irrigation with saline.
51700 Bladder irrigation, simple, lavage and/or instillation
Bladder irrigation and instillation are used to deliver medication directly to the bladder via a catheter. These medications are usually anti–inflammatory agents used to treat infection or conditions like Interstitial Cystitis.

Clinical Responsibility
When performing a bladder instillation, the physician uses a catheter to fill the patient's bladder with a therapeutic solution — often called a "bladder cocktail". This "cocktail" is made up of various protective and healing agents. The cocktail stays in the bladder for varying amounts of time, depending on the patient's tolerance to the drugs. The bladder is then drained through the catheter. Irrigation, another common procedure, involves passing a saline or therapeutic solution quickly in and out of the bladder. This "flushes" the bladder of clots or debris.

 

[Bernadette10]

Thank you!! I wish the CPT description was more specific.

 

[toria11]

51700 is not appropriate when irrigating a catheter, correct? I've seen mixed opinions on this, but I recently found this statement from the NCCI manual from 2022 "Irrigation of a urinary catheter is included in the global surgical package. CPT code 51700 shall not be misused to report irrigation of a urinary catheter." What if there was no surgery and the catheter is clogged?

 

[csperoni]

51700 is not appropriate when irrigating a catheter, correct? I've seen mixed opinions on this, but I recently found this statement from the NCCI manual from 2022 "Irrigation of a urinary catheter is included in the global surgical package. CPT code 51700 shall not be misused to report irrigation of a urinary catheter." What if there was no surgery and the catheter is clogged?

I would NOT use 51700 for catheter irrigation. I would include that work in the visit as I do not believe there is a separate code for foley (or other urinary catheter) irrigation.

 

[toria11]

I would NOT use 51700 for catheter irrigation. I would include that work in the visit as I do not believe there is a separate code for foley (or other urinary catheter) irrigation.

So for a patient with gross hematuria and clots, what documentation would you expect? Our providers often just say that they irrigated the catheter free of clots.. but they should be documenting that they irrigated the bladder free of clots?

 

[csperoni]

So for a patient with gross hematuria and clots, what documentation would you expect? Our providers often just say that they irrigated the catheter free of clots.. but they should be documenting that they irrigated the bladder free of clots?

The provider should document whatever they performed. As a coder, you can provide general education to document what they perform. You should not tell them to document something they did not perform in order to bill a code.
51700 Bladder irrigation, simple, lavage and/or instillation

 

[toria11]

The provider should document whatever they performed. As a coder, you can provide general education to document what they perform. You should not tell them to document something they did not perform in order to bill a code.
51700 Bladder irrigation, simple, lavage and/or instillation

I would never advise them to document something they did not perform. I was asking for clarification of the difference between the two procedures, but no worries if you do not know. I just wonder if my providers say they irrigated the catheter free of clots when in reality they irrigated the bladder and just haven't been documenting it correctly. What is the difference between irrigating the catheter free of clots in a patient with gross hematuria vs irrigating the bladder? The catheter is in the bladder after all.

 

[csperoni]

I would never advise them to document something they did not perform. I was asking for clarification of the difference between the two procedures, but no worries if you do not know. I just wonder if my providers say they irrigated the catheter free of clots when in reality they irrigated the bladder and just haven't been documenting it correctly. What is the difference between irrigating the catheter free of clots in a patient with gross hematuria vs irrigating the bladder? The catheter is in the bladder after all.

My apologies. I was reading your post as whether you should advise them to document differently even if currently documented correctly. I do not know enough about urology from a clinical perspective to understand the difference, and perhaps a discussion with your providers could be helpful. That should also help clarify about whether or not they are currently documenting well from a coding perspective.