Urology Coding Alert

Question: Should I use modifier -51 or modifier -59 to code multiple bladder lesions biopsied in a single session for a Medicare patient?

UCA Subscriber

Answer: Coding multiple bladder biopsies can be confusing because of all of the factors you have to consider before knowing whether the biopsies should be separately reported.

First, check the definition of the biopsy code to determine whether the code represents one or multiple biopsies. For example, code 52204 (Cystourethroscopy, with biopsy), most likely the code in question, only includes one biopsy and should be used multiple times to represent multiple biopsies. On the other hand, CPT code 43202 (Esophagoscopy, rigid or flexible; with biopsy, single or multiple) should be used only once, regardless of the number of biopsies taken during the indicated esophagoscopy.

In the case of 52204, you should use modifier -59 (Distinct procedural service) when multiple biopsies are taken through a standard cystourethroscopy for a Medicare patient. Using modifier -59 will indicate to the carrier that the code is billable multiple times because the biopsies were performed for lesions in different locations. So if two bladder biopsies are taken in the same surgical session, each for a separate lesion in a distinct location, you should code 52204 and 52204-59 for Medicare carriers. For private carriers, you may only need to report 52204-59 with the number of biopsies taken indicated in the units column. You should substantiate the use of modifier -59 with documentation of the locations of the multiple lesions and by sending each specimen in a separate jar that indicates the site of the biopsy.

In a more complicated example, if a urologist performs a transurethral resection of the bladder (TURB), 52224 (Cystourethroscopy, with fulguration [including cryosurgery or laser surgery] or treatment of MINOR [less than 0.5 cm] lesion[s] with or without biopsy), and he also performs a biopsy in another area of the bladder, the procedures should be coded 52224 and 52204-59.

Next check the method or methods used to take the multiple biopsies. When two biopsies are taken using more than one method, you will also need modifier -59 to get paid for both biopsies. For example, if the urologist biopsies a lesion using a snare technique and another using hot forceps, you should be paid for each biopsy.

Modifier -51 (Multiple procedures), on the other hand, should be used when you are reporting two separate biopsy codes that are not bundled. If the urologist biopsies a lesion in the bladder, 52204, and also takes a biopsy of the urethra, you should report 52204 and 53200-51 (Biopsy of urethra).