Urology Coding Alert

Question: I billed CPT 52214 and 52204-59 together, and Medicare denied 52214, paying only 52204-59 (which is the lesser charge). I appealed with notes, but the carrier still denied. I'm thinking I should refund the money paid on 52204 and just file 52214. How should I correctly code this?

Arizona Subscriber

Answer: You should not report 52214 and 52204 together. Deciding which is the correct code to properly represent the procedure your urologist performed depends on the clinical circumstances of the procedure. Do not base your coding -- and appeal -- on which code pays more.

Option 1: If the urologist only did a biopsy and fulgurated a bleeder within the biopsy site without treatment of a lesion, you should only report 52204 (Cystourethroscopy, with biopsy[s]) because this code includes the fulguration.

Option 2: If the physician biopsied a minor lesion and then fulgurated its base or any remaining part of the lesion, use 52224 (Cystourethroscopy, with fulguration [including cryosurgery or laser surgery] or treatment of MINOR [less than 0.5 cm] lesion[s] with or without biopsy) alone.

Don't forget: Use 52214 (Cystourethroscopy, with fulguration [including cryosurgery or laser surgery] of trigone, bladder neck, prostatic fossa, urethra, or periurethral glands) for fulguration of a bleeding vessel(s) such as in a case of radiation cystitis (no biopsy) or the treatment/fulguration of a Hunner's ulcer associated with interstitial cystitis.