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Urology Coding Alert

Reader Question:

Bladder Biopsies

Published on Sun Sep 01, 2002

Question: My physician recently performed multiple bladder biopsies, three to be exact, in a single session. Is modifier -51 the correct appendage to code properly for this? Will Medicare even pay for these multiple bladder biopsies?

Washington Subscriber

Answer: You are on the right track by turning to a modifier to achieve proper coding for multiple bladder biopsies, but be careful when choosing the appropriate modifier. Modifier -59 (Distinct procedural service) accurately captures the procedures, not modifier -51 (Multiple procedures).

The coding scenario for Medicare carriers would be the following:

  • 52204 (Cystourethroscopy, with biopsy)

  • 52204-59

  • 52204-59.

    To maintain the integrity of the sample, you should send each specimen in a separate jar indicating the site of the biopsy.

    For private carriers, you should record the number of biopsies performed in the unit column of the 1500 form with modifier -59 attached to one 52204 code on one line.

    If you code correctly, Medicare will pay for all of the bladder biopsies. More often than not, coders assume Medicare's policy for paying for multiple bladder biopsies mirrors that of multiple bladder tumors, a procedure not paid for by Medicare. Medicare will only pay for the largest tumor treated, resected or fulgurated, if the biopsies performed when treating a large tumor are for other, smaller tumors.

    In contrast, the multiple bladder biopsies for mapping the bladder for carcinoma in situ, showing no visible abnormalities, may be billed with code 52204 and 52204-59 for the multiple biopsies.

     

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