Urology Coding Alert

Question: My urologist transurethrally resected several bladder lesions of varying sizes. Should I bill according to the number of tumors or according to their combined weights?
     
Tennessee Subscriber
 
Answer: When a urologist removes more than one bladder tumor, selecting a code or codes based on the size or number of tumors may seem reasonable, but don't be so sure. CPT guidelines lack clarity when describing bladder lesion removal (52234, 52235 and 52240), but Medicare has a definite policy: Medicare instructs urologists to bill only one of the above tumor removal codes, coding only for the largest tumor resected.
 
With the above three codes in mind, for Medicare you should bill only one of these codes, the one single code for the largest single tumor removed. For private payers, add up, or aggregate, the tumor sizes and bill the code for the aggregate size using the total tumor volume in determining the CPT code to use.
 
Tumor size is based on a visual estimate of the tumor at cystoscopy. Select the tumor removal code based on this estimate. Use 52234 (Cystourethroscopy, with fulguration [including cryosurgery or laser surgery] and/or resection of; SMALL bladder tumor[s] [0.5 to 2.0 cm]) for 0.5 to 2.0 cm, 52235 (... MEDIUM bladder tumor[s] [2.0 to 5.0 cm]) for 2.0 to 5.0 cm, and 52240 (... LARGE bladder tumor[s]) for 5.0 cm or more. Use 52204 (Cysto-urethroscopy, with biopsy) for a biopsy of any size tumor.
 
For bladder biopsies at different bladder sites significantly removed from the original tumor resection, use codes 52204-59 and/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; Distinct procedural service).