Instillation of anticarcinogenic agent with cyto.

hencked

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I have a urology case where a cyto with a resection of bladder tumor is done, CPT code 52234. On another area of the bladder he biopsies an unusual spot, code 52204 and then instills mitomycin, endoscopically, code 51720. The diagnosis is bladder cancer. CCI bundles 52204 and 51720 into 52234 with a 1. We are thinking we could bill 52005 with a 59 as it is a separate area of the bladder from the tumor resection and the path came back cystitis. But what if it would have came back as cancer also, then should be bill? Should we unbunble the 51720 or just not code?

Any guidance on this senario would be greatly appreciated. Thanks!

Deb H.
 
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AmyHyman

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51720 with 52234

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I have a urology case where a cyto with a resection of bladder tumor is done, CPT code 52234. On another area of the bladder he biopsies an unusual spot, code 52204 and then instills mitomycin, endoscopically, code 51720. The diagnosis is bladder cancer. CCI bundles 52204 and 51720 into 52234 with a 1. We are thinking we could bill 52005 with a 59 as it is a separate area of the bladder from the tumor resection and the path came back cystitis. But what if it would have came back as cancer also, then should be bill? Should we unbunble the 51720 or just not code?

Any guidance on this senario would be greatly appreciated. Thanks!

Deb H.
 
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Can anyone answer this question: can 51720 be reported at the same session as 52234? Per documentation the mitomycin was instilled in the OR after the biopsy was completed.

Kathy F.
 

emcee101

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Since the are non-overlapping services, I think you could justify unbundling with an XU modifier.
 
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In order to report the 51720 separately, this would need to be performed later that day or in the recovery room.

The code will be considered included with the 52234 unless it was performed outside of the surgical session. I have read this from a few resources.

So in this scenario, no 51720 would not be separately billable.

I recently looked into this issue myself. :)

~Melissa, CPC
 
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