Results 1 to 5 of 5

Mitomycin and TURBTs?

  1. #1
    Question Mitomycin and TURBTs?
    New Call-to-action
    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.

  2. #2
    Portland Rose City Oregon Chapter
    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.


    Drew Vinson
    NW Urology

  3. #3
    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!

  4. #4
    Portland Rose City Oregon Chapter
    Correct. Then you can report it with a 59 modifier (or, more specifically, an XE to note separate encounter).

    Drew Vinson
    NW Urology

  5. #5
    Awesome! So, now we know!

    Thank you again!!

Similar Threads

  1. Mitomycin compound for TURBT
    By mmcvey in forum Outpatient Facilities
    Replies: 0
    Last Post: 10-20-2016, 01:44 PM
  2. Mitomycin
    By in forum Medical Coding General Discussion
    Replies: 2
    Last Post: 03-09-2015, 09:24 AM
  3. Mitomycin C reimbursement
    By jfuse2 in forum ENT/Otolaryngology
    Replies: 0
    Last Post: 07-10-2014, 09:59 AM
  4. mitomycin billing
    By janetstiles in forum Billing/Reimbursement
    Replies: 1
    Last Post: 03-25-2013, 12:13 PM
  5. Mitomycin in the ASC
    By dkws2001 in forum Ophthalmology/Optometry
    Replies: 1
    Last Post: 02-17-2012, 02:37 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
Enjoying Our Forums?

AAPC forums are a benefit of membership. Joining AAPC grants you unlimited access, allowing you to post questions and participate with our community of over 150,000 professionals.

Join Now Continue Reading Without Full Access

Already a Member?


Close Message

In addition to full participation on AAPC forums, as a member you will be able to:

  • Access to the largest healthcare job database in the world.
  • Join over 150,000 members of the healthcare network in the world.
  • Be a part of an industry leading organization that drives the business side of healthcare.
  • Save anywhere from 10%-50% with exclusive member discounts on courses, books, study materials, and conferences.
  • Access to discounts at hundreds of restaurants, travel destinations, retail stores, and service providers. AAPC members also have opportunities to save on heath, life, and liability insurance.
  • Become a member of a local chapter and attend regular meetings.