Wiki 52235 with 51720 denials

[dlk]

Hello,
My doctor has been receiving denials for code combination 52235 with 51720 for instillation of Myocitin with modifier 59. The insurance company requests the operative report and then asks why the 51720 is a separate procedure.
(tumor resection done via cystoscope, scope removed; Foley inserted and myocitin injected into catheter).
Any ideas on what they are looking for??
Thank you.

 

[Kelly_Mayumi]

They are likely looking for if the service is indeed seperate. 52335 and 51720 are bundled to each other. If the patient is taken to another room and 51720 is instilled then it's appropriate to add -59.

 

[ahallman]

Is there any written information for this? I have a Provider that insists the instillation can be done directly after the TURBT. This isn't an issue of the CPTs but more about Modifier 59