Urology Coding Alert

Question: My physician always does CPT 51720 after he completes 52224, 52234, 52235 and 52240. The National Correct Coding Initiative states I need to unbundle with modifier 59, but I am not sure if 51720 is a distinct procedure.


Colorado Subscriber

Answer: If the instillation occurs in the operating room immediately after one of the following procedures, you should consider the chemotherapy installation as an integral part of the treatment:

• 52224--Cystourethroscopy, with fulguration (including cryosurgery or laser surgery) or treatment of MINOR (less than 0.5 cm) lesion(s) with or without biopsy

• 52234--Cystourethroscopy, with fulguration (including cryosurgery or laser surgery) and/or resection of; SMALL bladder tumor(s) (0.5 up to 2.0 cm)

• 52235--...MEDIUM bladder tumor(s) (2.0 up to 5.0 cm)

• 52240--...LARGE bladder tumor(s).

Therefore, the installation isn't separately billable. You can, however, consider 51720 (Bladder installation of anticarcinogenic agent [including detention time]) a separate procedure if your urologist performs the chemotherapy installation later in the day, such as in the recovery room or in the patient's hospital room.

In this instance, you can report 51720 and append modifier 59 (Distinct procedural service) to show that the installation was separate from the resection of the bladder tumor and your urologist performed it at a separate encounter on the same day.

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.