AHA Coding Clinic® for HCPCS - 2012 Issue 2; Ask the Editor

Resection of Bladder Tumor

A patient underwent a cystoscopy which revealed the presence of a bladder tumor. He is now scheduled to have the tumor measuring 2.5 cm and the stalk measuring 1.2 cm resected. The tumor was resected along with other abnormal tissue. Contrast was injected bilaterally via a cone-tipped catheter with no signs of abnormalities noticed. An 18-French catheter was placed and 40 mg of mitomycin was instilled into the bladder for about 30 minutes. We reported CPT codes 52235, Cystourethroscopy, with fulguration (including cryosurgery or laser surgery) and/or resection of; MEDIUM bladder tumor(s) (2.0 to 5.0), and 51720, Bladder instillation of anticarcinogenic agent (including retention time), but these codes produce an edit when reported together. Our coders have been instructed by a physician advisor to report both CPT codes and append modifier 59, Distinct Procedural Service, to code 51720. His reasoning was that not all patients who have tumors resected have an anticarcinogenic agent instilled into the bladder. Therefore, CPT code 51720 should be separately reported with modifier 59 appended. Can you clarify whether it would be appropriate to report both codes? ...

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