Urology Coding Alert

Question: When we report multiple medium bladder tumors resected in a single surgical session, can we append modifier -22 to the removal code to indicate that more than one tumor was resected? We are using one code to report all of the tumors because the patient has a Medicare carrier.

Pennsylvania Subscriber

Answer: Although you may feel that your urologist should receive additional reimbursement for removing more than one tumor, using modifier -22 (Unusual procedural services) to gain the additional reimbursement is not proper coding.

Modifier -22 will increase reimbursement when its use is approved by a carrier; however, removing multiple bladder tumors that are reported by one code is far from "unusual" by Medicare's standards. According to the definition of the codes for transurethral resection of the bladder (TURB), 52224-52240, the work required to perform multiple biopsies is already included in the fee for the code that represents the largest tumor resected.