Anesthesia Coding Alert

The May 2002 Anesthesia and Pain Management Coding Alert discussed coding for various procedures associated with cystoscopy ("Associated Procedures Key to Cystoscopy Coding," pages 44-46). Some of the codes reported for use with cystoscopy with TURB (transurethral resection of bladder neck) or with lithotripsy were incorrect or incomplete. The article's discussion of cystoscopy with TURB stated that it should be coded with the five-unit code 52500 (Transurethral resection of bladder neck [separate procedure]) instead of the three-unit code 52000 (Cysto-urethroscopy [separate procedure]). Selecting a code that includes both the cysto and tumor resection procedures and is based on the tumor's size would be more appropriate. These would include:

52234 Cystourethroscopy, with fulguration (including cryosurgery or laser surgery) and/or resection of; SMALL bladder tumor(s) (0.5 to 2.0 cm)
52235 MEDIUM bladder tumor(s) (2.0 to 5.0 cm)
52240 LARGE bladder tumor(s). In the information regarding coding for lithotripsy, 50590 (Lithotripsy, extracorporeal shock wave) is used for ESWL (extracorporeal shock wave lithotripsy), as noted in the article. When a cysto is performed with lithotripsy, you should report it with the code for lithotripsy that is not ESWL (52353, Cysto-urethroscopy, with ureteroscopy and/or pyeloscopy; with lithotripsy [ureteral catheterization is included]).