Oncology & Hematology Coding Alert

Question: My oncologist transurethrally resected several malignant bladder lesions of varying sizes. Should I bill according to the number of tumors or according to their combined weights?

Tennessee Subscriber 
 
Answer: When an oncologist removes more than one bladder tumor, selecting a code or codes based on the size or number of tumors may seem reasonable, but don't be so sure. CPT guidelines lack clarity when describing bladder lesion removal (52234, 52235 and 52240), but Medicare has a definite policy: Medicare instructs physicians to bill only one of the above tumor removal codes, coding only for the largest tumor resected.
 
If you report 52234, 52235 or 52240 to private payers, add up, or aggregate, the tumor sizes and bill the code for the aggregate size using the total tumor volume in determining the CPT code to use. 
 
Physicians base tumor size on a visual estimate of the tumor at cystoscopy. Select the tumor removal code based on this estimate. Use 52234 (Cystourethroscopy, with fulguration [including cryosurgery or laser surgery] and/or resection of; SMALL bladder tumor[s] [0.5 to 2.0 cm]) for 0.5 to 2.0 cm, 52235 (... MEDIUM bladder tumor[s] [2.0 to 5.0 cm]) for 2.0 to 5.0 cm, and 52240 (... LARGE bladder tumor[s]) for 5.0 cm or more. Use 52204 (Cystourethroscopy, with biopsy) for a biopsy of any size tumor. 
 
For bladder biopsies at different bladder sites significantly removed from the original tumor resection, use codes 52204-59 and/or 52224-59 (Cystourethroscopy, with fulguration [including cryosurgery or laser surgery] or treatment of MINOR [less than 0.5 cm] lesion[s] with or without biopsy; Distinct procedural service).