Urology Coding Alert

Cut Through Bladder Coding Confusion

Question: Our physician performed a transurethral resection of bladder tumors for a 68-year-old male. Two tumors were seen, one on the right lateral wall and one on the dome. The tumor on the right lateral wall measured 3 cm, and the tumor on the dome measured less than 0.5 cm. These tumors were resected completely including bladder wall tissue. Documented tumors: a medium malignant tumor on the right lateral wall, and a minor malignant tumor on the dome.
     
Delaware Subscriber
 
Answer: Report codes 52235 (Cystourethroscopy, with fulguration [including cryosurgery or laser surgery] and/or resection of; MEDIUM bladder tumor[s] [2.0 to 5.0 cm]) and 52224-59 (Cystourethroscopy, with fulguration [including cryosurgery or laser surgery] or treatment of MINOR [less than 0.5 cm] lesion[s] with or without biopsy; Distinct procedural service). 

Code CPT 52235 accounts for the resection of the largest visible bladder tumor, in this case a tumor of medium size, and code CPT 52224 is for the resection of the minor tumor, 0.5 cm or less.

Some coders mistakenly assume the policy that says only one of the bladder tumor resection codes (52234-52240) can be reported in a single surgical session also includes cystoscopy codes 52204 (Cystourethroscopy, with biopsy) and 52224.

While Medicare instructs coders to report only one of the three bladder tumor resection codes - 52234, 52235 and 52240 - Medicare does not indicate that this "one-code-only" rule applies to the bladder biopsy codes, 52204 and 52224, hence the billing of CPT code 52224 in the above example.

Remember that 52204 and 52224 cannot be billed together because 52204 is bundled into 52224 and cannot be unbundled with any modifier.