Urology Coding Alert
Tumor Smaller Than 0.5
Alaska Subscriber
Answer: If the surgeons operative note says the tumor is smaller than 0.5 centimeters, use either 52204 (cystourethroscopy, with biopsy) or 52224 (cystourethroscopy, with fulguration [including cryosurgery or laser surgery] or treatment of MINOR [less than 0.5 cm] lesion[s] with or without biopsy). Select 52204 if there is no fulguration or treatment of the lesion. Neither of these codes refers to resection.
For coding, it doesnt matter how you treat the tumor -- resection, fulguration, or even biopsy itself, which can result in the removal of very small tumors. Even 52234 (cystourethroscopy, with fulguration [including cryosurgery or laser surgery] and/or resection of; SMALL bladder tumor[s] [0.5 to 2.0 cm]) doesnt require the use of a resectoscope. If the surgeon chooses to use a resectoscope to remove a very small tumor, that is a clinical, not a coding, decision.
Before choosing a code, make sure you have the accurate tumor size. Coders should never use the pathology report for tumor size because it will reflect a tumor that is smaller than the one the urologist visualized when performing the surgery. When the tumor is placed in formalin, it shrinks. If the tumor was 0.5 centimeters according to the pathology report, it was bigger before. Any bladder-tumor removal must be coded based on tumor size, and you can get the accurate size only from the operative note. The urologist must form the habit of noting the size of even the smallest bladder tumors in the operative note.
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