Ob-Gyn Coding Alert

Question: I am working a denial for a physician who originally coded 52224. After review of the op notes, however, I feel 52234 better describes the procedure he performed. I noticed 52224 carries 31.13 relative value units (RVUs) and 52234 only

6.91 (non-facility performed as outpatient surgery). The odd part is that the physician also coded 52005 (8.19 RVUs), which bundles in with 52234 (6.91 RVUs) but actually carries a higher RVU value. I also noticed that 52224 (31.13 RVUs)

bundles in with 52234 (6.91 RVUs). If 52224 (31.13 RVUs) is considered included in 52234 (6.91 RVUs), should the more involved procedure not a higher RVU value?

New Hampshire Subscriber

Answer: Where the physician performs these procedures determines the valuation of these codes.

You will note that 52234 (Cystourethroscopy, with fulguration [including cryosurgery or laser surgery] and/or resection of; SMALL bladder tumor[s] [0.5 up to 2.0 cm]) has the same RVUs for the inpatient and outpatient setting. The reason is

because Medicare considers this to be only an inpatient procedure.

On the other hand, 52224 (Cystourethroscopy, with fulguration [including cryosurgery or laser surgery] or treatment of MINOR [less than 0.5 cm] lesion[s] with or without biopsy) can be an inpatient or outpatient procedure (hence the huge practice

expense RVU for the outpatient setting). 

-Non-facility- refers to an office, not outpatient surgery. An outpatient surgery site is still a facility location since the facility bills part of the service. The higher RVUs in the office setting are meant to recoup practice costs for owning the equipment

required to do the procedure.