Oncology & Hematology Coding Alert

Question: Our physician used laser ablation for the management of a tumor in the urinary bladder. The details of histopa­thology examination are not available. We are still not sure if the growth treated was benign or malignant. How can we report this service?

Maryland Subscriber

Answer: For laser ablation treatment for bladder tumor, you choose from the following codes:

• 52234 – Cystourethroscopy, with fulguration (including cryosurgery or laser surgery) and/or resection of; SMALL bladder tumor(s) (0.5 up to 2.0 cm)
• 52235 – … MEDIUM bladder tumor(s) (2.0 to 5.0 cm)
• 52240 – … LARGE bladder tumor(s).

Check the size of bladder tumors: The codes 52234-52240 specify the size of the tumor. Bladder tumors are classified as small, medium, and large if these are less than 2.0 cm, 2.0 to 5.0 cm, or more than 5.0 cm in size, respectively.

Pathology of the tumor (benign or malignant) does not guide the choice of codes for laser ablation. The appearance of the tumor during ablation may provide impressions about the behavior of the tumor and the physician may like to confirm this by a histopathological examination.

Diagnosis codes: For a benign neoplasm of the bladder, you submit ICD-10-CM code D30.3 (Benign neoplasm of bladder). For malignant neoplasms of the bladder, you choose from the ICD-10-CM code set C67.0 (Malignant neoplasm of trigone of bladder) to C67.9 (Malignant neoplasm of bladder, unspecified). You select a code based on the anatomical location of the growth in the bladder.

Not sure of histology: If a bladder biopsy is pending and you aren’t yet sure if the tumor is benign or malignant, you submit code D49.4 (Neoplasm of unspecified behavior of bladder).