Our doctor is called to consult on a patient in urinary retention. The hospital nursing staff is unable to pass the Foley catheter. During the consult, the doctor places the Foley catheter. The physician bills for the hospital-visit evaluation and management and CPT 51702, but I think I’m thinking too much because the lay terms of 51702 state the physician supplies the Foley… so it’s still OK for my provider to report the E/M and 51702, and the hospital will bill for the supplies only. Is this correct? Or is there a modifier that can be added to the 51702 in order for the doctor to bill for the placement?
With our complicated billing system, it is easy to “think too much.” Before we get to the meat of your question, we should issue a warning: Don’t let the “lay terms” sidetrack your thinking. “Lay” descriptions are helpful to many in understanding what a service or procedure may entail, but these descriptions are not a part of CPT or any other official rule set. In short, consider them as additional information, but do not use this information to guide or change your coding.
For your questions, we “think” it would help to reword your question and then answer with more than a simple yes or no.
First, is it OK to bill for 51702 in the hospital setting?
When you’re paid for the procedure in the office, you are paid a higher fee than when you perform the same procedure at the hospital. Look up 51702 in AUACodingToday, scroll down to “fee schedule,” and look at “facility fee.” The national payment is $27. The non-facility fee, or office fee, is $65.88. This additional payment is for the catheter and the office expenses. In short, it is not only OK to report 51702 in the hospital, it is in fact the correct way to report the simple insertion of a Foley catheter in the hospital.
Also by the Painters: It's time to declare war on costly billing mistakes
Second, do you need a modifier to report 51702 in the hospital?
No, the correct place of service is all you need to communicate to the payer that the hospital is charging a “facility fee” in addition to your charge for the procedure.
We assume that you do know you will need a modifier –25 attached to the E/M code to report the consultation (E/M code) on the same date as the catheter insertion.