How To Use CPT Code 90586

CPT 90586 describes the administration of the Bacillus Calmette-Guerin (BCG) vaccine for the treatment of bladder cancer. This article will cover the description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, similar codes and billing examples.

1. What is CPT Code 90586?

CPT 90586 is used to describe the administration of the Bacillus Calmette-Guerin (BCG) vaccine for the treatment of bladder cancer. This vaccine consists of live bacteria derived from an attenuated strain of tubercle bacilli. The BCG treatment is used to hamper tumor growth in patients with bladder cancer.

2. Official Description

The official description of CPT code 90586 is: ‘Bacillus Calmette-Guerin vaccine (BCG) for bladder cancer, live, for intravesical use.’

3. Procedure

1. The physician administers the BCG vaccine via a slow drip into the bladder through a urethral catheter.

4. Qualifying circumstances

CPT 90586 is used for patients with bladder cancer who require treatment with the BCG vaccine. The vaccine is administered intravesically, directly into the bladder. It is important to note that this code is specific to the treatment of bladder cancer and should not be used for other indications.

5. When to use CPT code 90586

CPT code 90586 should be used when administering the BCG vaccine for the treatment of bladder cancer. It is important to ensure that the patient has a confirmed diagnosis of bladder cancer and that the vaccine is being administered intravesically.

6. Documentation requirements

To support a claim for CPT code 90586, the following documentation is required:

• Confirmation of the patient’s diagnosis of bladder cancer
• Evidence of the administration of the BCG vaccine intravesically
• Date and time of the procedure
• Any relevant notes or observations made during the procedure
• Signature of the physician administering the vaccine

7. Billing guidelines

When billing for CPT code 90586, ensure that the vaccine is being administered for the treatment of bladder cancer. It is important to follow the specific guidelines for reporting this code and to ensure that it is not reported with other codes that may overlap or duplicate the services provided.

8. Historical information

CPT code 90586 was added to the Current Procedural Terminology system on January 1, 1999. There have been no updates or changes to the code since its addition.

9. Examples

1. A patient with bladder cancer receives the BCG vaccine intravesically as part of their treatment plan.
2. A physician administers the BCG vaccine to a patient with non-muscle invasive bladder cancer to prevent tumor recurrence.
3. A urologist performs an intravesical instillation of the BCG vaccine for a patient with high-grade bladder cancer.
4. A patient with carcinoma in situ of the bladder undergoes intravesical BCG therapy to target and destroy cancer cells.
5. A physician administers the BCG vaccine to a patient with recurrent bladder cancer to stimulate an immune response against the tumor.
6. A urologist performs a BCG instillation for a patient with superficial bladder cancer to reduce the risk of disease progression.
7. A patient with non-invasive bladder cancer receives the BCG vaccine intravesically to prevent tumor recurrence and progression.
8. A physician administers the BCG vaccine to a patient with low-grade bladder cancer to enhance the body’s immune response against cancer cells.
9. A urologist performs an intravesical instillation of the BCG vaccine for a patient with carcinoma in situ of the bladder to eradicate cancer cells.
10. A patient with high-risk bladder cancer undergoes intravesical BCG therapy to improve treatment outcomes and reduce the risk of disease recurrence.