Wiki Extensive Bladder Clot Evacuation

[toria11]

Hi there! Would you code this as 52214, 52001-22-59? The provider would like some sort of compensation for the increased time/difficulty. Thanks for your input!!

Postoperative Diagnosis
Radiation cystitis hematuria clot retention

Procedure Performed
1. TUR coagulation of radiation cystitis 2. Irrigation and evacuation of clots prolonged time 1 hour. increased difficulty factor

Type of Anesthesia
General

Indications
Gross hematuria

Findings
Radiation cystitis a bladder full of organized clots great difficulty irrigating them could not completely get rid of all the organized clots

Unanticipated Events/Complications
Organized clots

Specimen(s)
None

Technique/Description of Procedure
Patient was placed in the dorsal lithotomy position prepped and draped usual manner a 25 resectoscope was introduced into the urethra and passed into the bladder he was found to have a bladder Completely full of clots which many of them were organized and solid. We irrigated with the Toomey syringe and with the Ellik evacuator for at least 1 hour the resectoscope was used to break up clots and to cut through some of them we were able with prolonged irrigation to remove most of the organized clots except for some that were coming from the anterior surface. We fulgurated multiple bleeding sites from the radiation cystitis. Will finally was elected to stop the procedure put him back on 3 way catheter with plans to come back later in the week and look again and hopefully some of the clots will have lysed. We did not have any evidence of any significant active bleeding at the termination of the procedure. We placed a 3 way 22 Foley in the bladder. He was transferred recovery.

Implants and Devices
Three way catheter

Estimated Blood Loss
Minimal

Patient Condition/Disposition
Condition stable transferred to recovery room and to medical-surgical floor continue CBI

 

[liqgold2@aol.com]

I would suggest the following coding for your clinical scenario:
52001 this code includes the extra work to clear multiple obstructing clots out of the bladder. This code is the higher paying code and is bundled into 52214, and
52214-59 or -XU for the fulguration of the bladder bleeding vessels from radiation cystitis, N30.41. As per payer rules we are to and have switched the modifiers to this code to make billing more understanding as this code is the lesser of the charges compared with 52001 and now becomes the secondary code.

 

[toria11]

Thank you for your response! You teach me so much. I always thought the modifier had to be appended to the column two code. I also always thought 52214 was the higher paying code because Codify says the RVUs for 52214 are 22.98 and 52001 is 12.82 RVUs. Thanks for your help as usual.

 

[liqgold2@aol.com]

The reverse and different RVU values you noted for 52214 and 52001 were the RVUs when the procedures were performed in a non facility such as an office. The procedures that I coded with the reverse RVUs were performed in a facility as far as I can determine.

 

[toria11]

Thank you!