Charlene Posted Thu 21st of May, 2020 09:53:31 AM
I see Medicare allows $3.00 for P9612. Is P9612 allowable for the catheterization during nurse visit (99211) to collect clean urine specimen when a patient presents symptomatic and history is taken, Rx called in, UA is performed? Is P9612 allowable with E&M by physician?
SuperCoder Answered Fri 22nd of May, 2020 06:38:06 AM
Thank you for your Question!
Any qualified personnel who are employees of the physician can report 99211, including medical assistants, licensed practical nurses, technicians and other aides working under the physician's direct supervision. The provider performs a temporary catheterization for the purpose of obtaining a urine specimen for analysis for a single patient. As, this catheterization is temporary and is neither a therapy or for diagnostic purposes, such as determining post void residual volume. if you have sufficient supporting documentation for the office visit you can bill E/M service led to your provider’s decision that bladder catheterization was necessary.
Use procedure code 51701, Insertion of non-dwelling bladder catheter, if the provider performs catheterization for diagnostic or therapeutic reasons. See also procedure codes 51702, Insertion of a temporary indwelling catheter, simple, e.g., Foley, and 51703, Complicated catheter insertion or removal. When the urologist performs straight catheterization for a clean urine specimen for urinalysis or culture and sensitivity, Medicare will not accept 51701. Instead, you should submit HCPCS code P9612 (Catheterization for collection of a specimen, single patient, all places of service).
If you can show that the E/M service is separate and identifiable from the catheterization, and you have separate documentation for both services, including modifiers will help show the insurer that you should receive separate reimbursement. By adding Modifier -25 informs the payer that the office visit is a significant, separately identifiable service from the catheterization. File the claim with -25, but be aware that some payers will either deny the E/M as included in the catheterization or more likely will include the catheterization in the office visit.
Note: HCPCS code P9612 is currently payable on the clinical lab fee schedule. Its status indicator of “A” would provide payment for the service whenever it is billed, regardless of the presence or absence of other reported services. his code applies regardless of the place of service.
Hope that Helps!