Urology Coding Alert

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 (hes in the clinical hallway at time of administration). Historically, 99211 has been assigned whenever the patient gets chemotherapy. It seems to me that the 99211 would be included in both 51720 and 96400 if the patient comes in and the nurse asks the patient how they are feeling, and then does the administration of chemo. Do you agree that 99211 would be included in 51720 and 96400? Also, under what circumstances would it be appropriate to report a 99211 with these codes?

Anonymous Iowa Subscriber

Answer: A separate visit code should not be reported in addition to the chemotherapy services unless a significant, separately identifiable and medically necessary service was provided beyond the normal preprocedure care. The situation you describe of routinely (and incorrectly) assigning 99211 whenever a patient gets chemotherapy has often occurred in hospital-based clinics in order to capture nursing time. However, the Medicare Hospital Manual states, do not report the following (visit) codes if the sole reason for the visit was to undergo a laboratory, radiology, or diagnostic test, a surgical or medical procedure, or to receive psychiatric services, chemotherapy, physical therapy, occupational therapy, speech-language pathology or cardiac rehabilitation. It would only be appropriate to separately report an evaluation and management (E/M) service if the patients condition required additional medical services.