Did you know that providers can bill for the bladder instillation of anticarcinogenic agent (CPT 51720) on the same day as a bladder tumor resection if the instillation occurs after the procedure, sometime later on the same day? Below are the key details to know when billing for this scenario, as timing and other variables will dictate what is and what is not separately billable.
In order for the provider to bill CPT Code 51720 at the same time as a bladder tumor resection (52234, 52235, 52240), the two procedures must be performed in separate sessions, on the same date of service. If the documentation states that the instillation occurred in the operating room immediately after the surgical procedure, then it is considered an integral part of the treatment and not separately billable. However, 51720 can be considered a separate procedure if it is performed by the provider later in the day, such as in the recovery room or in the patient’s hospital room. Individual notations should be documented by the provider for each procedure to support that they were performed separately.
Attaching Modifier 59 (a distinct procedural service) to Code 51720 will indicate that the instillation was separate from the resection of the bladder tumor and performed in a separate encounter with the patient on the same day. Other key codes to remember include:
- 51720 Bladder instillation of anticarcinogenic agent (including retention time)
- 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 Cystourethroscopy, with fulguration (including cryosurgery or laser surgery) and/or resection of; MEDIUM bladder tumor(s) (2.0 to 5.0 cm)
- 52240 Cystourethroscopy, with fulguration (including cryosurgery or laser surgery) and/or resection of; LARGE bladder tumor(s)
As billing rules continue to change, it’s important to stay up-to-date so you can use them to your advantage. If you have any questions about billing CPT 51720 with bladder tumor resections or need support reviewing your documentation, our team is here to help. Contact us to set up a conversation.