Urology Coding Alert

Question: My doctor performed an evacuation of a clot and fulguration of a bladder tumor. I have no idea where to start. What codes should I report?

New York Subscriber

Answer: If the patient was in urinary clot retention, and your urologist did a cystoscopy, evacuated all the clots through the scope or a large catheter that he placed separately, and then fulgurated the bladder tumor, code as follows:

Use CPT 52001 -59 (Cystourethroscopy with irrigation and evacuation of multiple obstructing clots; distinct procedural service) for the cystoscopy and clot evacuation. Add modifier -59 to unbundle 52001 from the bladder treatment codes.

Use CPT 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 fulguration of a small bladder tumor.

Remember: Base the treatment code on the size of the bladder tumor resected. If the tumor is large, report 52240 (Cystourethroscopy, with fulguration and/or resection of; LARGE bladder tumor[s]) as the primary surgical procedure, since it carries more RVUs (13.71 for a non-facility) than 52001 (7.70). The CPT Codes for treatment of smaller bladder tumors have fewer RVUs than 52001, so they would become the secondary procedures for coding purposes, as above. Continue to always add modifier -59 to CPT code 52001 to break the bundles.