How To Use CPT Code 51720

CPT 51720 refers to the bladder instillation of an anticarcinogenic agent, a common treatment for bladder cancer. This article will cover the description, procedure, qualifying circumstances, usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 51720.

1. What is CPT 51720?

CPT 51720 is a medical procedure code used to describe the bladder instillation of an anticarcinogenic agent, which is a common treatment for bladder cancer. This procedure involves instilling an anticarcinogenic agent into the bladder through a catheter and retaining it for a specific period before draining it out. The purpose of this treatment is to target and destroy cancer cells within the bladder.

2. 51720 CPT code description

The official description of CPT code 51720 is: “Bladder instillation of anticarcinogenic agent (including retention time)”.

3. Procedure

The 51720 procedure involves the following steps:

  1. Preparation of the patient, including positioning and sterilization of the area.
  2. Insertion of a catheter into the patient’s bladder through the urethra.
  3. Instillation of the anticarcinogenic agent into the bladder via the catheter.
  4. Retention of the anticarcinogenic agent in the bladder for a specified period, usually ranging from 1 to 2 hours.
  5. Draining of the anticarcinogenic agent from the bladder through the catheter.
  6. Removal of the catheter and post-procedure care.

4. Qualifying circumstances

Patients eligible to receive CPT code 51720 services are those diagnosed with bladder cancer and deemed suitable candidates for bladder instillation therapy by their healthcare provider. Factors that may influence eligibility include the stage and grade of the cancer, the patient’s overall health, and the presence of any contraindications or risk factors that may affect the safety or efficacy of the treatment.

5. When to use CPT code 51720

It is appropriate to bill the 51720 CPT code when a healthcare provider performs a bladder instillation of an anticarcinogenic agent as a standalone procedure or in separate sessions from other related procedures, such as tumor resection. If the instillation occurs immediately after a surgical procedure in the same session, it is considered an integral part of the treatment and should not be billed separately using CPT code 51720.

6. Documentation requirements

To support a claim for CPT 51720, the following information should be documented:

  • Patient’s medical history and diagnosis of bladder cancer.
  • Indication for bladder instillation therapy and the specific anticarcinogenic agent used.
  • Detailed description of the procedure, including the steps performed, the retention time of the anticarcinogenic agent, and any complications or adverse reactions encountered.
  • Post-procedure care instructions and follow-up plan.

7. Billing guidelines

When billing for CPT code 51720, it is essential to follow the appropriate guidelines and rules to ensure accurate reimbursement. Some tips and codes that apply to CPT code 51720 include:

  • Only report CPT code 51720 when the bladder instillation is performed as a standalone procedure or in separate sessions from other related procedures, such as tumor resection.
  • Ensure that the documentation supports the medical necessity of the procedure and includes all required information.
  • Be aware of any payer-specific guidelines or requirements that may affect the billing and reimbursement of CPT code 51720.

8. Historical information

CPT 51720 was added to the Current Procedural Terminology system on January 1, 1990. The code underwent a change on January 1, 2007, when the previous descriptor “Bladder instillation of anticarcinogenic agent (including detention time)” was updated to the current descriptor.

9. Similar codes to CPT 51720

Five similar codes to CPT 51720 and how they differentiate from CPT 51720 are:

  1. CPT 51700: This code describes bladder irrigation, which is a procedure to flush the bladder with a sterile solution, rather than instilling an anticarcinogenic agent.
  2. CPT 51701: This code refers to the insertion of a non-indwelling bladder catheter, which is a temporary catheter used for a single instance of bladder drainage, without the instillation of an anticarcinogenic agent.
  3. CPT 51702: This code describes the insertion of a temporary indwelling bladder catheter, which remains in the bladder for a longer period, but does not involve the instillation of an anticarcinogenic agent.
  4. CPT 51705: This code refers to the change of a cystostomy tube, which is a tube inserted through the abdominal wall into the bladder, without the instillation of an anticarcinogenic agent.
  5. CPT 51710: This code describes the irrigation of the bladder for the removal of blood clots or debris, rather than the instillation of an anticarcinogenic agent.

10. Examples

Here are 10 detailed examples of CPT code 51720 procedures:

  1. A patient with non-muscle invasive bladder cancer undergoes a bladder instillation of Bacillus Calmette-Guerin (BCG) as part of their treatment plan.
  2. A patient with recurrent bladder cancer receives a bladder instillation of mitomycin C following a previous course of BCG therapy.
  3. A patient with carcinoma in situ of the bladder undergoes a bladder instillation of an anticarcinogenic agent as an alternative to more invasive treatments.
  4. A patient with a history of bladder cancer receives a bladder instillation of an anticarcinogenic agent as part of a maintenance therapy regimen.
  5. A patient with a high risk of bladder cancer recurrence undergoes a bladder instillation of an anticarcinogenic agent as a prophylactic measure.
  6. A patient with bladder cancer receives a bladder instillation of an anticarcinogenic agent as part of a clinical trial evaluating the efficacy of a new treatment.
  7. A patient with bladder cancer undergoes a bladder instillation of an anticarcinogenic agent as a palliative treatment to alleviate symptoms and improve quality of life.
  8. A patient with bladder cancer receives a bladder instillation of an anticarcinogenic agent as a neoadjuvant therapy prior to surgery to reduce tumor size.
  9. A patient with bladder cancer undergoes a bladder instillation of an anticarcinogenic agent as an adjuvant therapy following surgery to reduce the risk of recurrence.
  10. A patient with bladder cancer receives a bladder instillation of an anticarcinogenic agent as a salvage therapy after other treatments have failed to control the disease.

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