Urology Coding Alert

Question: We are a group of urologists that bill under a common group NPI. One of our physicians, Dr.A, did a TURBT (CPT 52240 ), which has 0 global days, on a patient with a diagnosis of bladder cancer. Within two weeks, another physician in our practice, Dr. B,performed a TURP (CPT 52601 ), which has a 90-day global, for cancer of the bladder that had invaded the prostate. The patient then returned to see Dr. A for discussion of further treatment for his extensive cancer of the bladder. How should I code for these procedures and the office visit?

Michigan Subscriber

Answer: For the first procedure, code the transurethral resection of a bladder tumor (TURBT) performed by Dr. A using 52240 (Cystourethroscopy,with fulguration [including cryosurgery or laser surgery] and/or resection of; LARGE bladder tumor[s] ) as you suggested. You should assign a bladder cancer diagnosis code, such as 188.x (Malignant tumor of bladder).

Next: For the transurethral resection of the prostate (TURP) that Dr. B performed, you should report 52601 (Transurethral electrosurgical resection of prostate,including control of postoperative bleeding, complete [vasectomy, meatotomy, cystourethroscopy, urethral calibration and/or dilation, and internal urethrotomyare included]).

You should use 185.0 (Malignant neoplasm of prostate) as the diagnosis code for this procedure. Code 185 indicates a malignant tumor of the prostate, which may represent an adenocarcinoma, a transitional cell tumor (as in this case), a squamous cell carcinoma, or sarcoma of the prostate.

Pitfall: Dont be tempted to report the same diagnosis code for the second procedure that you did for the first. A diagnosis of a bladder tumor (188.x) may not indicate medical necessity for payment of a TURP (52601). Even though the cancer began in the bladder, Dr. B is treating a tumor in the prostate. The code descriptor for 185 does not specify the type of prostate tumor. Therefore, you can use this diagnosis code to report a transitional cell tumor.

Finally: Report the office visit with code 9921x (Office or other outpatient &) based on time spent face to face with the patient in the office discussing the further treatment of the extensive bladder tumor.Because you are in the 90-day global of the TURP (52601), add modifier 24 (Unrelated evaluation and management service by the same physician during a postoperative period) to the E/M code. You should bill for the office discussion since the diagnosis codefor the office visit will be 188.x, a different and separate ICD-9 code from the 185 diagnosis for the TURP.