Urology Coding Alert

Don't let cloudy CPT Guidelines for bladder lesion removal throw you off. Use the guidelines issued by the Centers for Medicare and Medicaid Services to steer clear of improper coding.

Determining the proper coding of transurethral resections of bladder tumors of different sizes has plagued urology coders. You know the routine: The urologist performs a transurethral resection of a large bladder tumor and during the same operative episode performs a transurethral resection of a medium bladder tumor, both of which are in completely different locations within the bladder, and you must figure out if you can get paid separately for each tumor resection or if you should only report the code for the largest tumor resected.

We got the scoop from Linda Dietz, RHIA, CCS, CCS-P, National Correct Coding Initiative coding specialist for AdminaStar Federal Inc. in Indianapolis, on the proper coding techniques for:

Interpret the 52240 Bundles:Size Really Does Matter

According to Dietz, the bundling of codes 52234 and 52235 into code 52240 was part of the "national rebundling edits that HCFA[now CMS] implemented back in 1992" then reincorporated into the NCCI Edits in January 1996. She points out that these two bundles were assigned the modifier indicator of "1," which allows the use of modifier -59 (Distinct procedural service) to unbundle 52234 and 52235 when different-size tumors are resected in different sites in the bladder.

Because the codes in these edits are covered under Medicare's multiple-endoscopy rules for payment, Dietz says, "CMS is willing to allow the codes for separate bladder tumors at different sites as long as modifier -59 is used."

However, when the urologist resects tumors in the same area of the bladder for a Medicare patient, report only the code for the largest tumor resected, says Petra Reising, CPC, coding specialist for the Urology Group in Fairfield, Ohio.

Dietz agrees. Normally, by CPT definition, the resection of small tumors would be included in the fee for the resection of large tumors unless they are tumors at different sites, she says.

Urologists estimate tumor size during the cystoscopy segment of the procedure. Use the estimate for the largest bladder tumor to determine which code you should use to represent the procedure when submitting claims to Medicare. For example, if the urologist resects three bladder tumors, one 1.2 cm, another 2.3 cm and a third 6.0 cm, the only code that should be reported to Medicare for the urologist's services is 52240.

Coding for multiple bladder tumors really gets complicated when you determine your units of service.

When you are coding one or more bladder tumors of the same size all small, medium or large only bill with the appropriate code for the size and for one unit of service, Dietz instructs coders. "However, if you had different sizes of bladder tumors removed, then multiple codes in the range 52224-52240 would be used with 1 unit of service and a modifier -59 if they were at different sites of the bladder."