Urology Coding Alert

Question: I know that the instillation of mitomycin is bundled into CPT 52235 , but it can be unbundled with modifier 59. Can you tell me when it is appropriate to unbundle these procedures?


New Mexico Subscriber


Answer: If the operating urologist performed the instillation after the patient had left the operating room--that is, the instillation occurred in the recovery room or on the floor in the hospital--you may report 51720 (Bladder instillation of anticarcinogenic agent [including retention time]).

Append modifier 59 (Distinct procedural service) to indicate that the instillation occurred later on the same day and at another location (not in the operating room) and during another encounter. Also remember that to be paid, the operating surgeon (not a resident, nurse, or physician assistant) must perform the instillation.

Alternative: If the urologist performed the instillation immediately after surgery in the operating room, the instillation would be considered and included as part of the complete operative procedure and not a separately billable service.

Example: If your urologist performed the instillation outside of the operating room after a transurethral resection of a bladder tumor (TURB), you should report the following:

• 52235 (Cystourethroscopy, with fulguration [including cryosurgery or laser surgery] and/or resection of; MEDIUM bladder tumor[s] [2.0 to 5.0 cm]) for the TURB

• 51720-59 for the bladder instillation. Answers to Reader Questions and You Be the Coder contributed by Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology, State University of New York, Stony Brook; and Morgan Hause, CCS, CCS-P, privacy and compliance officer for Urology of Indiana LLC, a 31-urologist practice in Indianapolis.