AHA Coding Clinic® for HCPCS - 2012 Quarter 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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Article Overview
This article reviews a bladder tumor procedure case and the coding considerations raised by the combination of surgical and bladder instillation services. It is aimed at coders, billers, and physician advisors who need to understand how the encounter is being interpreted for CPT reporting and compliance review.
Why This Topic Matters
It helps readers identify whether the article is relevant to bladder tumor procedure coding and to situations where multiple CPT services are reported together in a single encounter.
What You Will Learn
- How the encounter is framed for professional coding review
- Which CPT service categories are part of the discussion
- How coding edits can arise when multiple services are reported together
- What types of documentation context are referenced in the case summary
Who Should Read This
- Medical coders
- Billing staff
- Physician advisors
- Compliance staff
Codes Discussed
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