Urology Coding Alert

Question: Can we bill two instillation codes in a scenario with the following documentation:

"Heparin Instillation: Heparin Instillation

Patient was prepped using a solution of lidocaine, DMSO, Sodium bicarbonate gel at the urethral meatus and suprapubic heat prior to the procedure. Betadine prep was performed followed by insertion of an 8 French pediatric catheter without incident. A combination of the medications below were mixed and instilled. The catheter was then removed.

Heparin 40,000 unit injection solution; Lot #: WN401N; Expiration Date:12/15

Bupivicaine (PF) 0.5% (5mg/ml) injection solution; Lot #:41-248-DK; Expiration Date:5/1/16

Lidocaine (PF) 20 mg/mL (2%) intravenous solution; Lot #:37-340-DK; Expiration Date:1/1/16

Sodium Bicarbonate 1 mEq/mL (8.4%) intravenous solution; Lot #:44-131-EV, Expiration Date:8/1/16

Pain Scale: Pain level before the procedure using Visual Analogue Scale/FACES scale: 7

Pain level during the procedure using Visual Analogue Scale/FACES scale: 10

Alleviated by: Pain level after the procedure using Visual Analogue Scale/FACES scale: 5

Silver Nitrate: Silver Nitrate Instillation

A time out was taken and consent form was signed.

Patient was prepped using a solution of lidocaine, DMSO, Sodium bicarbonate gel at the urethral meatus. Iodine prep was performed followed by insertion of an 8 French pediatric catheter without incident. Silver nitrate was instilled into the bladder and held for fifteen minutes, then voided. Silver Nitrate 0.2% (2mg/mL) injectable solution; Lot #: 142833@1; Expiration Date:2/8/15"

Oregon Subscriber

Answer: You should report 51700 (Bladder irrigation, simple, lavage and/or instillation) only once as this code has a medically unlikely edit (MUE) of 1. This edit indicates that you can only bill this code once per encounter/day.

The clinical scenario in your example does not indicate that modifier 59 (Distinct procedural service), one of the new X modifiers, or other modifier would be correct in obtaining payment for a second 51700 billing.