Wiki Mitomycin and TURBTs?

[Jessim929]

Has anyone come across the administration of chemo drugs on a bladder tumor resection? My colleague and I recently started seeing a couple of the doctors we code for dictating out specifically that a dose of Mitomycin was administered after the tumor resection, so we were coding out the 52234/52235/52240 as appropriate for the size of the tumor and then 52250-59 for the Mitomycin and another colleague says that the drug is included in the resection. AUA's matrix indicates that a modifier is needed. We read the code description of the TURBT that the 52250 is if the lesions are treated with the chemo drug, and since they did both, we coded both.

Any feedback is appreciated.

 

[drewvinson23]

First, the instillation of Mitomycin is coded with CPT 51720.

If the Mitomycin is injected directly after the tumor resection, then it is considered part of the resection and should not be unbundled. Here is an excerpt from a Urology Coding Update that explains this:

"Question: My physician always does CPT 51720 after he completes 52224, 52234, 52235 and 52240. The National Correct Coding Initiative states I need to unbundle with modifier 59, but I am not sure if 51720 is a distinct procedure.


Colorado Subscriber


Answer: If the instillation occurs in the operating room immediately after one of the following procedures, you should consider the chemotherapy installation as an integral part of the treatment:

• 52224--Cystourethroscopy, with fulguration (including cryosurgery or laser surgery) or treatment of MINOR (less than 0.5 cm) lesion(s) with or without biopsy

• 52234--Cystourethroscopy, with fulguration (including cryosurgery or laser surgery) and/or resection of; SMALL bladder tumor(s) (0.5 up to 2.0 cm)

• 52235--…MEDIUM bladder tumor(s) (2.0 up to 5.0 cm)

• 52240--…LARGE bladder tumor(s).

Therefore, the installation isn’t separately billable. You can, however, consider 51720 (Bladder installation of anticarcinogenic agent [including detention time]) a separate procedure if your urologist performs the chemotherapy installation later in the day, such as in the recovery room or in the patient’s hospital room.

In this instance, you can report 51720 and append modifier 59 (Distinct procedural service) to show that the installation was separate from the resection of the bladder tumor and your urologist performed it at a separate encounter on the same day."

Hope this helps.

Sincerely,

Drew Vinson
CPC
NW Urology

 

[Jessim929]

That does help! A lot!

So, just to clarify, if the dictation states administered in the recovery room (or later), it can be billed separately, but if it's done while in the OR, it can not, correct?

Thank you!

 

[drewvinson23]

Correct. Then you can report it with a 59 modifier (or, more specifically, an XE to note separate encounter).

Drew Vinson
CPC
NW Urology

 

[Jessim929]

Awesome! So, now we know!

Thank you again!!

 

[nyckimmie]

Hello, Coding for an OP facility, I'm seeking insight for this issue.
I see plenty of coding advice from Urology Assoc. and Codify, etc. that say the mitomycin -C instillation (51720) would need to be performed at a separate encounter (recovery room, etc), than the TURBT (52224-52240) to unbundle. And it makes sense, because I can't tell why the CCI edit was created to begin with. What I don't see are is anyone referencing these 2 Coding Clinics for HCPCS , that clearly instruct to unbundle. Has anyone had experience with unbundling based on these coding clinics?
4th Qtr. 2017 "CPT codes 52235 and 51720 are not inherently a component of the other and when supported by documentation, modifier 59 may be appended to show that the procedures were separate and distinct. Therefore, based on the operative report submitted, report CPT code 51720, Bladder instillation of anticarcinogenic agent (including detention time), in addition to CPT code 52235, Cystourethroscopy, with fulguration (including cryosurgery or laser surgery) and/or resection of; MEDIUM bladder tumor(s) (2.0 to 5.0 cm), for the procedures performed. Modifier 59, Distinct Procedural Service, would be appended to show that the procedures are separate and distinct from each other.
2nd qtr. 2012 - Cystourethroscopy with fulguration and bladder instillation, would be appropriately reported with CPT codes 52235 and 51720, with modifier 59 appended to the additional code.
Thank you.