Reader Question:
TURBT
Published on Sun Jul 01, 2001
Question: How should we code for an office visit after a TURBT? The patient returns to the office to have BCG (bacille Calmette-Guerin) instillation procedures. Do we need two different diagnoses to charge for the office visit and the BCG? Which modifier is needed?
Pennsylvania Subscriber
Answer: Tumor removal codes (52224-52240) have zero-day global periods, so no modifier is needed. You can also bill the office visit for the instillation. Use the same diagnosis code for the office visit and the BCG instillation that you did for the surgery.
For the instillation, code 51720 (bladder instillation of anticarcinogenic agent [including detention time]) and J9031 (BCG live [intravesical], per installation) for BCG. If you make an assessment as to the next dose of BCG to be administered, you can charge an E/M service as well. Bill 99211 if the nurse does the assessment, and 99212 if the assessment is made by a urologist or a midlevel provider. Append modifier -25 (significant, separately identifiable E/M service by the same physician on the same day of the procedure or other service) to the office visit.
The diagnosis code for the BCG and the office visit would be the malignant bladder cancer code (188.xx). Coders may wonder whether they should bill 188.xx after a TURBT because they presume that the lesion is gone. But unless you have clinical and pathological proof that the cancer is gone, continue to list it.
For Medicare, you can use 188.xx for the instillation (51720) and the E/M service. Private companies, however, often demand a separate diagnosis for each. For example, you could bill the bladder tumor for one, and carcinoma in situ for the other.
