Urology Coding Alert

Question: In order to know which CPT code to use for a cystolithalopaxy (52317 or 52318), or bladder tumors (52234, 52235, 52240), I am writing to ask what the criteria are in determining the size of calculi or bladder tumors. Should the size be determined by measuring the circumference, the diameter, centimeters, etc.?

Anonymous Ohio Subscriber

Answer: Per the Coders Desk Reference, use 52317 for tumors under 2.5 cm and use the 52318 coder for those over 2.5 cm, measured at the largest dimension. For the bladder tumors, the 52234 should be used for tumors of 0.5-2.0 cm; the 52235 for tumors of 2.0-5.0 cm; and for tumors larger than 5.0 cm, 52240.

Editors note: Answers to these questions were provided by Susan Callaway-Stradley, CPC, CCS-P, an independent coding consultant based in North Augusta, S.C., and the American Academy of Professional Coders 1998 Coder of the Year; Kerry Lyons, RN, office manager at Southeastern Ohio Urology Inc.; Lynn R. Rogers, office manager, Professional Economics Inc., Bloomington, Ind., and a member of the Healthcare Billing & Management Association.; and Linda Vaughn, CPC, a reimbursement specialist at the Cleveland Clinic Foundations urology department.