Urology Coding Alert

Primary tumors of the prostate arise from cells within the prostate. A secondary prostate tumor develops in the prostate and spreads to another organ, such as the bladder. Secondary tumors will rarely appear in the bladder from prostate cancer, after the prostate has been removed. Coding for the bladder-tumor removal and diagnosis is a challenge because the prostate codes cannot be used, because the patient does not have a prostate. Yet a secondary tumor has occurred at the newly formed bladder neck.
Outside of Postoperative Period  
If the patient had a radical prostatectomy (55840-55845) years ago, report CPT 52240 (Cystourethroscopy, with fulguration [including cryosurgery or laser surgery] and/or resection of; LARGE bladder tumor[s]) for the bladder-tumor removal if the tumor at the bladder neck is large enough to obstruct the orifice. Otherwise use one of the lesser codes (52224-52235) based on the size of the tumor.
 
Diagnosis codes: Use 198.1 (Secondary malignant neoplasm of other specified sites; other urinary organs) for the primary diagnosis, and 185 (Malignant neoplasm of prostate) as the secondary diagnosis, says Laura Siniscalchi, RHIA, CCS, CCS-P, CPC, senior consultant, Deloitte and Touche, Boston. Do not use ICD9 V10.46 (Personal history of malignant neoplasm; genital organs; prostate) because the patient still has prostate cancer, even though the prostate was removed. Code 198.1 with 185 tells the payer that (1) the tumor at the bladder neck is secondary, and (2) the primary cancer was prostate cancer. Do not use 188.8 (Malignant neoplasm of bladder; other specified sites of bladder) because the bladder is not the primary site of the cancer.
Within Postoperative Period 
 
 
Even if the bladder-tumor removal were within the postoperative period, you could still be paid in full for it, says Margaret Atkinson, billing manager for the Center for Urologic Care in Voorhees, N.J. Use modifier -79 (Unrelated procedure or service by the same physician during the postoperative period) because the site and the diagnosis codes are different for the prostatectomy and the tumor removal. If you try to bill for the bladder-tumor removal within the postoperative period of a radical prostatectomy, and you use the same diagnosis codes for both, you will get a fee reduction, Atkinson says.