Chapter 1: Bladder Chemotherapy

This common treatment for bladder cancer involves introducing an anticarcinogenic agent into the bladder by drops
(instilling) through a catheter. The physician leaves the agent in the bladder for a period of time before draining it out
through the catheter.

51720 Bladder instillation of anticarcinogenic agent (including retention time).

ICD-9-CM Codes

188.0 Malignant neoplasm of trigone of urinary bladder

188.1 ... dome of urinary bladder
188.2 ... lateral wall of urinary bladder
188.3 ... anterior wall of urinary bladder
188.4 ... posterior wall of urinary bladder
188.5 ... bladder neck
188.6 ... ureteric orifice
188.7 ... urachus
188.8 ... other specified sites of bladder
188.9 ... bladder, part unspecified
233.7 Carcinoma in situ of bladder
233.9 ... other and unspecified urinary organs.

Report 51720 with tumor resection only if performed in separate session: Physicians frequently instill
chemotherapy drugs into the bladder with bladder tumor removal procedures. If the instillation occurs in the OR
immediately after the surgical procedure, you should consider the chemotherapy installation as an integral part of the
treatment.
For instance, if the surgeon performs instillation during the same surgical session as a cystourethroscopic bladder
tumor resection, do not report 51720. The bladder tumor resection codes are:

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 to 5.0 cm)
52240 ... LARGE bladder tumor(s).

The Correct Coding Initiative (CCI) bundles 51720 into the bladder tumor resection codes, and the edits have a modifier
indicator of "1," meaning you can break the bundle under appropriate clinical circumstances.
So you can consider 51720 a separate procedure if your physician performs the chemotherapy instillation 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) or other appropriate modifier to show that the instillation was separate from
the bladder tumor resection, and your doctor performed it at a separate encounter on the same day.
Watch out for SNF consolidated billing: Medicare's skilled nursing facility (SNF) consolidated billing program
requires physicians who perform services for SNF patients to forward the technical portions of any services, including
51720, to the SNF to be billed by the SNF to its Medicare intermediary for payment. Medicare carriers will not make
payment to physicians and suppliers for technical components of physician services furnished to beneficiaries in the
course of a Medicare Part A covered stay. Likewise, Medicare will not reimburse the physician for the chemotherapy
agent, such as Bacille Calmette-Guerin (BCG): You must bill the SNF for your costs for the agent, using J9031 (BCG live
[intravesical] per instillation).
Therefore, for SNF patients, bill your Medicare carrier directly for the professional portion of the services with modifier

CPT 2014 American Medical Association. All rights reserved.

26 (Professional component) appended. File the claim for the technical portion and the chemotherapy agent as though
the SNF were an insurance carrier, putting the name of the facility at the top of the CMS form, and your billing
information, place of service, etc., below. To receive payment for the technical aspects of services your physician
performs on SNF patients and for the chemotherapy agents and other drugs, you may need to have a set contract with
the SNF because of Medicare Part A requirements.

- Published on 2015-01-01

CPT 2014 American Medical Association. All rights reserved.