Urology Coding Alert

Question: We do a lot of BCG instillations (51720, J9031) and Lupron injections (96400, J9217). The administration is done by a registered nurse (RN), under the indirect supervision of a physician. Historically, 99211 has been assigned whenever the patient gets chemotherapy. Should 99211 be included in 51720 and 96400? Also, under what circumstances would it be appropriate to report a 99211 with these codes?

Kentucky Subscriber

Answer: Yes, the nursing services are included in both these procedure codes. A separate evaluation and management (E/M) services code (e.g., 99211) should be reported only when a separately identifiable E/M service is provided and documented. If one of the procedures you mention is performed as a result of an E/M service on the same day or the patient needs medical evaluation due to a separate issue (not necessarily a separate diagnosis), it would be appropriate to report an E/M service code with a -25 modifier in addition to the procedure code. Note that no -25 modifier is needed with 96400, only with 51720.