How To Use CPT Code 53661

CPT 53661 describes the dilation of the female urethra, including the use of a suppository and/or instillation, during subsequent visits. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 53661?

CPT 53661 is used to describe the dilation of the female urethra during subsequent visits. This procedure involves the insertion of dilators, usually of increasing size, to widen the urethra and promote proper urine passage. Additionally, a suppository or instillation of medication may be used to relieve a urethral stricture.

2. Official Description

The official description of CPT code 53661 is: ‘Dilation of female urethra including suppository and/or instillation; subsequent.’

3. Procedure

1. During the procedure, the physician inserts a suppository and performs instillations to dilate the urethra.
2. After lubricating the area, dilators of different diameters are inserted to gradually widen the passage.
3. This code specifically applies to subsequent visits for urethral dilation.

4. Qualifying circumstances

CPT 53661 is performed to treat female urethral strictures, which occur when part of the urethra narrows due to injury or infection. This procedure is intended to allow for proper urine passage. It is important to note that this code is specifically for subsequent visits for dilation.

5. When to use CPT code 53661

CPT code 53661 should be used when performing urethral dilation during subsequent visits. It is important to ensure that the patient has already undergone an initial dilation procedure and is returning for further treatment. This code should not be used for the initial dilation procedure.

6. Documentation requirements

To support a claim for CPT 53661, the physician must document the following information:

• The patient’s diagnosis and the need for subsequent urethral dilation
• The use of a suppository and/or instillation during the procedure
• The date and duration of the visit
• Details of the dilation procedure, including the sizes of dilators used
• Any complications or adverse reactions
• The physician’s signature

7. Billing guidelines

When billing for CPT 53661, it is important to ensure that the procedure is performed during a subsequent visit and not the initial dilation. This code should not be reported with other codes for the same procedure. It is important to follow the specific guidelines provided by the payer to ensure accurate billing and reimbursement.

8. Historical information

CPT code 53661 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates or changes to the code since its addition.

9. Examples

1. A patient with a history of urethral stricture undergoes subsequent urethral dilation using dilators of increasing size.
2. During a follow-up visit, a suppository is inserted, and instillations are performed to dilate the female urethra.
3. A physician performs urethral dilation on a patient who has previously undergone the initial dilation procedure.
4. After lubricating the area, the physician inserts dilators to widen the urethra during a subsequent visit.
5. A female patient with a urethral stricture receives dilation treatment during a follow-up appointment.
6. During a subsequent visit, a suppository is used, and dilators are inserted to widen the female urethra.
7. A patient returns for further urethral dilation, and the physician performs the procedure using dilators of different sizes.
8. After an initial dilation, the patient undergoes subsequent urethral dilation during a follow-up visit.
9. A suppository is inserted, and dilators are used to dilate the female urethra during a subsequent visit.
10. A physician performs urethral dilation on a patient who has previously undergone the initial dilation procedure.