Urology Coding Alert

Question: My urologist successfully inserted a 16-French foley catheter into the patient’s bladder without encountering any problems. This allowed for the effective emptying of the bladder. Following that, my urologist proceeded to administer gemcitabine through the catheter, allowing it to remain in the bladder for a duration of one hour. During this time, the catheter was securely plugged to ensure proper delivery of the medication. After one hour, the gemcitabine was emptied out, and docetaxel was instilled via the catheter. The patient will urinate out the docetaxel after one hour. The patient will follow up in the next month for the same regimen. Can I bill twice for the instillation of the drugs with code 51720?

AAPC Forum Subscriber

Answer: You should report 51720 (Bladder instillation of anticarcinogenic agent (including retention time)) only once. If you supplied the medications, bill for both using the appropriate J code. For the gemcitabine, report J9201 (Injection, gemcitabine hydrochloride, not otherwise specified, 200 mg). For the docetaxel, report J9171 (Injection, docetaxel, 1 mg). Check your urologist’s documentation for the amounts administered to ensure you bill the correct units.

This treatment is sometimes used by urologists for patients with recurrent non-muscle-invasive bladder cancer (NMIBC) for whom intravesical Bacillus Calmette-Guerin (BCG) treatment has not worked, and radical cystectomy is not advised or wanted.

According to Stephanie Stinchcomb Storck, CPC, CPMA, CUC, CCS-P, ACS-UR, longtime urology coder and consultant in Summerfield, Florida, “Because the drugs were instilled with the same catheter, CPT^® 51720 cannot be reported twice. The same goes if the catheter was removed and another catheter was used to instill the second medication. Medicare’s Medically Unlikely Edits only allows reporting of one instillation procedure.”

Lindsey Bush, BA, MA, CPC, Development Editor, AAPC