Forum - Questions & Answers

Jan 29th, 2015 - amtartaglione 2 

Bladder instillations

I have a doc who is instilling a heparin & normal saline into the bladder for interstitial cystitis, he insists the correct code for this service is 51720 Bladder Instillation of anticarcinogenic agent including retention time. However, I believe code 51700 Bladder irrigation, simple lavage, and/or instillation seems to be more appropriate since it is not specific to cancer therapy.

What code selection is most appropriate for the procedure; a urethral catheter is inserted, instills 10,000 units heparin in 60 ml normal saline for bladder instillation. Patient tolerates well & will follow-up in one week

Jan 30th, 2015 - LBAROGIANIS 250 

re: Bladder instillations

You are correct!... Your doctor is wrong. I will show you the example on AMA:

CPT® 51700: A #16 Foley catheter is placed, and the bladder is drained. A total of 50 cc of dimethyl sulfoxide is placed in the bladder, and the catheter is clamped for 15 minutes. The bladder is then drained, and the catheter is removed.

CPT® 51720: A 72-year-old man is four weeks postoperative transurethral resection of a noninvasive transitional carcinoma of the blad-der. He is a candidate for intravesical bacille Calmette-Guerin (BCG) therapy. BCG is reconstituted and placed in the bladder per BCG protocol. Possible side effects of the BCG treatment are carefully reviewed with the patient.

Description of Procedure (51720)

Work day prior to surgery: Check to be sure the chemotherapeutic drug is available (BCG is the most common, less commonly used are Thiotepa, Interferon and Mitomycin). Check the schedule for the following day. Check with scheduling staff to see if the patient was notified, as drug has been ordered. Review the laboratory studies (eg complete blood cell count (CBC) if Thiotepa). Work day of surgery: Review procedure and post-procedure recovery with the patient and family. Answer patient and family questions; be sure informed consent is in record. Review voiding after BCG is instilled. Review urinalysis result to ensure it is infection free. Follow OSHA guidelines when the drug is mixed and prepared.

The patient is placed supine on the exam table and the genitalia are prepped. Local anesthetic is instilled into the urethra and a 16 French straight catheter is placed. Follow OSHA guidelines. Any residual urine is drained. The drug (most com-monly BCG) is allowed to flow from a syringe by gravity slowly into the bladder. The catheter is removed and all items are carefully disposed of in a zip-lock bag per OSHA guidelines and then placed into a special chemotherapy waste container.

Feb 2nd, 2015 - amtartaglione 2 

re: Bladder instillations

Thank you for the information

Feb 2nd, 2015 - amtartaglione 2 

re: Bladder instillations

can you provide me with the exact reference in which you provided me this answer? Is this directly from the AMA site, part of CPT® assistant or otherwise

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