Urology Coding Alert

Question: Does the pathology report have to be positive for malignancy before we can report CPT^® codes 52234-52240? What if the pathology report states chronic cystitis, cystitis cystica, etc.?

Maryland Subscriber

Answer: In general, the term “tumor” means any abnormal growth, which may or may not be malignant. Procedures in the code range 52234-52240 are based on the size of the tumor being treated rather than the pathology of the tumor. Each one specifies a size range for the tumor:

• 52234 – Cystourethroscopy, with fulguration (including cryosurgery or laser surgery) and/or resection of; SMALL bladder tumor(s) (0.5 up to 2.0 cm)
• 52235 – … MEDIUM bladder tumor(s) (2.0 to 5.0 cm)
• 52240 – … LARGE bladder tumor(s).

Most urologists can determine endoscopically when a bladder tumor is malignant. For these lesions, choose from the ICD-10 diagnosis code set C67.0 to C67.9 (Malignant neoplasm of bladder, unspecified) based on the bladder location of the tumor.

Other options: For benign bladder tumors, append ICD-10 code D30.3 (Benign neoplasm of bladder). If a bladder biopsy is pending, append diagnostic code D49.4 (Neoplasm of unspecified behavior of bladder).