Urology Coding Alert

Reader Question:

BCG and Lupron Coding

Question: We do a lot of BCG instillations (51720, J9031) and Lupron injections (96400, J9217). The administration is done by a registered nurse (RN), under the indirect supervision of a physician. Historically, 99211 has been assigned whenever the patient gets chemotherapy. Should 99211 be included in 51720 and 96400? Also, under what circumstances would it be appropriate to report a 99211 with these codes?

Kentucky Subscriber

Answer: Yes, the nursing services are included in both these procedure codes. A separate evaluation and management (E/M) services code (e.g., 99211) should be reported only when a separately identifiable E/M service is provided and documented. If one of the procedures you mention is performed as a result of an E/M service on the same day or the patient needs medical evaluation due to a separate issue (not necessarily a separate diagnosis), it would be appropriate to report an E/M service code with a -25 modifier in addition to the procedure code. Note that no -25 modifier is needed with 96400, only with 51720.
You’ve reached your limit of free articles. Already a subscriber? Log in.
Not a subscriber? Subscribe today to continue reading this article. Plus, you’ll get:
  • Simple explanations of current healthcare regulations and payer programs
  • Real-world reporting scenarios solved by our expert coders
  • Industry news, such as MAC and RAC activities, the OIG Work Plan, and CERT reports
  • Instant access to every article ever published in Revenue Cycle Insider
  • 6 annual AAPC-approved CEUs
  • The latest updates for CPT®, ICD-10-CM, HCPCS Level II, NCCI edits, modifiers, compliance, technology, practice management, and more

Other Articles in this issue of

Urology Coding Alert

View All