AHA Coding Clinic® for HCPCS - 2017 Issue 4; Ask the Editor

Mitomycin-C instillation

A patient with previous history of low-grade superficial urothelial carcinoma underwent a transurethral resection of bladder tumor (TURBT) in March of 2014. Since that time, she has had several subsequent recurrences requiring TURBT’s. She is now scheduled to undergo a transurethral resection with post-procedural mitomycin-C instillation. Our dilemma is whether it would be appropriate to report both CPT codes 52235 and 51720 for this encounter? Coding Clinic for HCPCS indicates that it is, however, when we assign both codes there is an Integrated Outpatient Code Edit (I/OCE) Edit 40. Edit 40 indicates a Code 2 of a code pair that would be allowed by an NCCI if an appropriate modifier were present. Has the coding guidance changed? If so, what is the appropriate code assignment for the instillation of the mitomycin-C? ...

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