Urology Coding Alert

Key: Size does matter when it comes to bladder tumorsYour urologist removes multiple bladder tumors during one session. You should report multiple codes, right? Not so fast. You need to review your physician's documentation and pay attention to which payer you're reporting the procedure to before choosing your codes. Follow these expert pointers and you're sure to code right every time.Choose From 4 CodesWhen your urologist transurethrally removes tumors from a patient's bladder, your first step in choosing a code to report is to refer back to the physician's documentation.Look for notations about the size of the bladder tumor(s). CPT offers you four bladder tumor removal codes. As the code descriptors indicate, which code you report depends on the size of the tumor. In the documentation, your urologist should make a visual estimate of the size of the bladder tumor. Based on the size estimate documented, select one of four codes:• Use 52224 (Cystourethroscopy, with fulguration [including cryosurgery or laser surgery] or treatment of MINOR [less than 0.5 cm] lesion[s] with or without biopsy) for tumors measuring less than 0.5 cm• use 52234 (Cystourethroscopy, with fulguration [including cryosurgery or laser surgery] and/or resection of; SMALL bladder tumor[s] [0.5 up to 2.0 cm]) for 0.5 cm to 1.9 cm sized tumors• use 52235 (... MEDIUM bladder tumor[s] [2.0 to 5.0 cm]) for tumors measuring 2.0 cm to 5.0 cm• use 52240 (... LARGE bladder tumor[s]) for tumors  5.0 cm or larger.1 Code Is All You NeedAs you know, coding for multiple procedures doesn't always equal multiple codes. That's the case in coding for transurethral resection of multiple bladder tumors.Regardless of how many tumors your urologist removes, you usually report one code depending on the insurance carrier involved and the size of the tumors removed."You can only bill for one tumor," says Tina Lee, CPC, coding specialist with Urology Associates of Central California in Fresno. "If my docs indicate size I bill for the largest." "It's my understanding that if there are multiple tumors, you should code the size of the largest tumor," agrees Jeri Williams, administrative assistant with Urology Associates of Mobile in Alabama.How it works: For Medicare, you should not add up the sizes of every tumor the physician removes. Instead,choose the code that represents the size of the largest single tumor removed."Some private carriers, not all, will allow you to add up the tumors and get a larger size," says Shannon McGough, CMC, who works in Hospital Census in Texarkana, Texas. Therefore, for private payers, you should add up the sizes of all the tumors and choose your code based on this sum.Tip: Since not all private payers allow this practice of adding up the tumor sizes, you should check with [...]