Urology Coding Alert

Question: I've been told that we can report the instillation of novocaine into the bladder with a PVP. The only code I can come up with is 51700, but the NCCI edits bundle this code with a PVP procedure. Can I actually report this? If so, what code should I use?


Nebraska Subscriber

Answer: You cannot separately report the instillation of novocaine into the bladder. The reason is that you are correct about the bundling of the anesthesia administration and the PVP procedure. The National Correct Coding Initiative bundles 51700 (Bladder irrigation, simple, lavage and/or instillation) into the PVP code 52648 (Contact laser vaporization with or without transurethral resection of prostate, including control of postoperative bleeding, complete).

Because this bundle has a modifier indicator of "0," you can't unbundle the codes. Private carriers that follow the NCCI edits may also bundle these codes.

In addition, Medicare includes all anesthesia services (whether they be local, topical, or a block) in the operative procedure and they are not billable services. Instillation of novocaine into the bladder falls under "topical anesthesia." Private carriers also likely include topical anesthesia in the surgical package and would not consider them a payable service. Check with your local private carriers, however, to see if they may allow you to report the anesthesia service.