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Urology Coding Alert

READER QUESTION:

Submit J9031 Even for Wasted Amount

Published on Thu Nov 02, 2006

Question: A patient came in for BCG, and we mixed the instillation solution. But when the urologist inserted the Foley catheter and instilled the BCG, the patient had a severe bladder spasm, and the urologist could not give all of the BCG. How can I code this so that we can get paid for the BCG?


Florida Subscriber


Answer: You should report 51720 (Bladder instillation of anticarcinogenic agent [including detention time]) for the discontinued Bacille Calmette-Guerin (BCG) instillation. Append modifier 52 (Reduced services) since the urologist was not able to perform the full procedure and did not instill all of the drug solution into the bladder, and there was little or no retention time for the drug.

Remember: Report J9031 (BCG live [intravesical], per instillation) for the full vial, including the portion that was instilled and the wasted portion.

Tip: Be sure to have very clear documentation of the event available in case the carrier requests documentation.  
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