Urology Coding Alert

Question: If a physician assistant (PA) instills a Bacille bili de Calmette-Gurin (BCG) and checks with the patient to see how she is feeling, can we charge a 99211 plus the BCG codes, or just the BCG?

Nebraska Subscriber

Answer: In the example given, an evaluation and management (E/M) service would not be appropriate. Documentation of the status of the patient (e.g., feeling fine, no complaints) is part of the preoperative component for the instillation procedure and included in the payment for the procedure. The code for the instillation is 51720 (bladder instillation of anticarcinogenic agent [including detention time]). If, however, the PA is providing a separately identifiable E/M service prior to (e.g., new problem) or immediately after the instillation (e.g., to discuss other treatment options), an office visit, with modifier -25 (significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service) may be reported separately.

If a PA or nurse assesses the patient inquires about adverse effects from the last instillation and documents the responses on a checklist, and on the basis of the questions and answers decides to proceed with the next instillation, a judgment for continued treatment is made and this is a chargeable service. For the nurse, bill 99211-25 (office or other outpatient visit for the E/M of an established patient); for the PA or physician, bill 99212-25. The checklist provides documentation of the assessment, a payable service.


Answers to You be the Coder and Reader Questions were provided by Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology at the State University of New York in Stonybrook; and Sandy Page, CPC, CCS-P, co-owner of Medical Practice Support Services, a coding and compliance consultancy in Denver.