Urology Coding Alert

Question: We billed CPT 52224 and CPT 52235 -59 together, but 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: You should actually be reporting 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 for the transurethral resection of bladder tumor (TURBT).

Then, as a secondary surgical procedure, report 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) to 52224 to show that the procedures were distinct and separately reportable.