Urology Coding Alert

Question: We billed codes 52224 and 52235 together (appending modifier 59 to 52235). The payer denied 52235, stating it was bundled with 52224. My billing person says we have always billed that way and gotten paid. Has something changed or did we bill incorrectly?

North Carolina Subscriber

Answer: Your code choices are correct, but you have them in the wrong order. When reporting transurethral resection of bladder tumor (TURBT), you should submit 52235 (Cystourethroscopy, with fulguration [including cryosurgery or laser surgery] and/ or resection of; MEDIUM bladder tumor[s] [2.0 to 5.0 cm]) as the primary procedure code.

Then, as a secondary surgical procedure, include 52224 (Cystourethroscopy, with fulguration [including cryosurgery or laser surgery] or treatment of MINOR [less than 0.5 cm] lesion[s] with or without biopsy) for the resection of the smaller bladder tumor if the latter was located in a different and separate area of the bladder distinct from the larger bladder tumor. Remember to append modifier 59 (Distinct procedural service) or modifier XS (Separate structure, a service that is distinct because it was performed on a separate organ/structure) to 52224 to show that the procedures were distinct and separately reportable.