Urology Coding Alert

Question: Our urologist performed multiple bladder biopsies and transurethral resection (TUR) of the "prostatic bed" for bladder cancer. The patient had had a transurethral resection of the prostate (TURP) seven years prior. The urologist documented removing large amounts of tissue of papillary appearance from the prostatic bed. How should I code this?

New York Subscriber

 Answer: The urologist's documentation indicating a tumor in the "prostatic bed" suggests a transitional cell tumor of the bladder involving the prostatic bed and the prostatic urethra. In this case, report the appropriate code for transurethral resection of bladder tumor, 52235 (Cystourethroscopy, with fulguration [including cryo-surgery or laser surgery] and/or resection of; MEDIUM bladder tumor[s] [2.0 to 5.0 cm]) or 52240 ( LARGE bladder tumor[s]), depending on the documented size of the tumor.

 When the prostate gland has been resected, as suggested by the TURP performed seven years prior, the prostatic fossa and the bladder often become one cavity. So you can use the transurethral surgery codes for the urethra and bladder for tumors in the bladder, urethra, prostatic or anterior urethra.

 Depending on the material biopsied or resected in the bladder cavity, you may need to report either 52204-59 (Cystourethroscopy, with biopsy; Distinct procedural service) or 52224-59 (Cystourethroscopy, with fulguration [including cryosurgery or laser surgery] or treatment of MINOR [less than 0.5 cm] lesion[s] with or without biopsy).

 If you biopsy normal bladder mucosa for mapping of the bladder lining or suspect carcinoma in situ, use code 52204-59. If you remove and fulgurate a small lesion(s) (less than 0.5 cm), use code 52224-59. Modifier -59 is used to indicate to the carrier that the urologist biopsied separate lesions in the bladder cavity. If you remove larger lesions (more than 0.5 cm), you are not permitted to use 52234 and 52235, based on Medicare policy (see "Boost Tumor Resection Reimbursement in One Simple Step" in the June 2003 issue of Urology Coding Alert).