Wiki 52234 with 51720

[Melissa*Ever*Evolving]

In reviewing reasons why the 51720 (installation of anticarcinogenic agent) would be bundled into the 52234 (tumor removal), I have found that when the agent is administered during the operative session, it is considered included in the tumor removal.
If the agent is administered in the recovery room or the patient's room after the operative session, it is said to be allowed separately.

Question:
If I suggest to my urologist to start doing this to increase revenue, is that wrong? Would it be considered fraud or abuse in any way?

Sounds similar to providers scheduling an EGD on a separate day from a colonoscopy so they can be paid for both services instead of being bundled.

I just want to make sure it is not a problem before presenting to the urologist.

Thoughts?
Thank you in advance!

~Melissa, CPC

 

[tori_ryan24]

We suggested it to our Doctor (but he was not doing the 51720 at the HSP at all) he was only doing it in the hospital because of the whole bundling issue. But there was patients that he wanted to do as soon as the procedure was over.

He does them now for the ones who really need it. But his op notes are very clear. Patient is taken to recovery room in good condition. Once awaken the patient is started on mitomycin therapy........etc, etc, etc.

you have to be very clear in the break of care that way if your records are requested is will show very clearly it was not done intra-operatively.

Hope that this helps!