Urology Coding Alert

Differentiating between drugs may be your key to reimbursementDon't let bladder instillation procedures trip up your coding accuracy. With two similar bladder instillation codes, you're setting yourself up for denials if you aren't carefully checking your urologist's notes.Instillations are common in urology offices, so knowing which code to report is essential. As long as you know the bundling rules and type of drug your urologist is using, you'll code these claims like an ace every time.1. Choose 51700 for IC TreatmentsUrologists commonly perform bladder instillations to treat a variety of conditions. Your keys to choosing the proper code for the instillation are the patient's diagnosis and the types of drugs the physician uses.Often physicians use bladder instillation to treat interstitial cystitis (IC). For this form of instillation, you'll report the procedure using 51700 (Bladder irrigation, simple, lavage and/or installation)."We use 51700 for our IC treatments and then charge J codes for the drugs," says Teresa A. Dailey, CPC, coding specialist for Urology Center of Spartanburg in South Carolina.Other types: For bladder instillation of anticarcinogenic agents like BCG, you should report 51720 (Bladder instillation of anticarcinogenic agent [including retention time]).Good news: "Coding instillation services shouldn't be tricky, as long as you know the patient's diagnosis," says Karen Delebreau, CPC, PCS, coder with BayCare Clinic Urological Surgeons in Green Bay, Wis.Beware: Insurance carriers will only reimburse for instillations performed every seven days and will not pay if your urologist repeats instillations sooner than the seven days.2. Don't Forget the DrugsYou should report the appropriate J codes for the drug your urologist uses for the instillation. "For example, BCG is an anticarcinogenic that goes with 51720, whereas Heparin and Marcaine for an IC treatment go with 51700," Dailey says.Example: You should report Bacille Calmette-Guerin (BCG) with J9031 (BCG live [intravesical], per instillation) for the full vial, including any portion that was instilled and the wasted portion. For Heparin, use J1644 (Injection, heparin sodium, per 1,000 units), and for Marcaine report J3490 (Unclassified drugs), reflecting the number of units used in the appropriate box on the CMS-1500 form for any drug.Key: Get your urologist to document exactly why he's performing the instillation and the drugs he's using. "We ask that the procedure description includes the fact that the meds are being instilled into the bladder via a catheter, and that the med strength and dosage are clearly stated," Delebreau says.Pointer: The diagnosis you report for the instillations should be 233.7 (Carcinoma in situ, bladder) or 188.x (Malignant tumor of bladder). Most payers will accept these diagnoses as proof of medical necessity for the instillations but usually will not accept V10.51 (Personal history of bladder tumor). CPT coding policy dictates that you should use one [...]