Reimbursement Advisor

Suprapubic catheter insertion


Q Our practice is debating which code we should report for the placement of a suprapubic catheter—51010 or 51040. What is the difference between the 2?

A The code 51010 (aspiration of bladder; with insertion of suprapubic catheter) is preferred. It refers to the transabdominal placement of a specially designed suprapubic catheter; the aspiration confirms proper placement of the device within the bladder.

The code 51040 (cystotomy, cystotomy with drainage) is used less frequently, usually in conjunction with an abdominal Burch procedure. In this case, the surgeon performs a cystotomy to inspect the lumen of the bladder for any misplaced sutures. Then, he or she inserts a drainage catheter through the cystotomy incision and sutures it around the catheter.

It is important to note that some payers will not reimburse for a procedure that involves checking for suture placement (e.g., cystotomy) because it is considered a standard surgical technique. However, catheter placement is necessary to prevent urinary retention and is a separately billable part of the procedure (51010).

This article was written by Melanie Witt, RN, CPC, MA, former program manager in the Department of Coding and Nomenclature at ACOG. She is now an independent coding and documentation consultant. Her comments reflect the most commonly accepted interpretations of CPT-4 and ICD-9-CM coding. When in doubt on a coding or billing matter, check with your individual payer.

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