Urology Coding Alert

If you're not differentiating bladder biopsy codes CPT 52204 and CPT 52224 from their related bladder tumor resection codes, 52234-52240, you're not getting paid in full. Take a look at the scenario below, which shows how these services can be billed separately. The scenario: After obtaining informed consent, a 68-year-old Medicare patient was prepped and draped in the usual fashion. The patient was put in the dorsal lithotomy position and was administered general anesthesia. Transurethral resection instruments were inserted and 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 down to and including bladder wall tissue. Documented tumors: a medium tumor on the right lateral wall (188.2) and a minor tumor on the dome (188.1)

Coding solution: For this scenario, you should report codes CPT 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), says Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology at State University of New York, Stony Brook. Code 52235 accounts for the resection of the largest bladder tumor, in this case a tumor of medium size, and the resection of any small or medium tumors resected during that surgical session. However, code 52235 does not account for the resection of an additional, separate minor tumor(s). Whether you can separately report the resection of a minor tumor has been a point of lingering confusion, Ferragamo says. Many 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 codes 52204 (Cystourethroscopy, with biopsy) and 52224 (Cystourethroscopy, with fulguration [including cryosurgery or laser surgery] or treatment of MINOR [less than 0.5 cm] lesion[s] with or without biopsy). 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, Ferragamo says. According to the Medicare Carriers Manual, "The descriptors for codes 52234 through 52240 include the language 'tumor(s)'. This means that regardless of the number of tumors removed, only one unit of a single code can be billed on a given date of service. It is inconsistent to allow payment for removal of a small (code 52234) and a large (52240) tumor using two codes when only one code is [...]