Urology Coding Alert

Question: I'm confused about how to report removal of multiple bladder tumors. Would you explain whether I add up the sizes or just select the largest?


Texas Subscriber


Answer: Regardless of how many bladder tumors the urologist removes, you should report a single code. Based on the size estimates the physician documents in the operative report, you'll select one of four codes:

• Use 52224 (Cystourethroscopy, with fulguration [including cryosurgery or laser surgery] or treatment of MINOR [less than 0.5 cm] lesion[s] with or without biopsy) for less than 0.5 cm.

• Use 52234 (Cystourethroscopy, with fulguration [including cryosurgery or laser surgery] and/or resection of; SMALL bladder tumor[s] [0.5 up to 2.0 cm]) for 0.5 to 2.0 cm.

• Use 52235 (... MEDIUM bladder tumor[s] [2.0 to 5.0 cm]) for 2.0 to 5.0 cm.

• Use 52240 (... LARGE bladder tumor[s]) for larger than 5.0 cm.

Select one: Which code you report depends on the insurance carrier. For Medicare, you should not add up the sizes of every tumor the physician removes. Instead, choose the code that represents the size of the largest single tumor removed.

For private payers, however, you should add up the sizes of all the tumors and choose your code based on the sum.

Example: The urologist removes five tumors from a patient's bladder that are each 0.5 cm in size. For Medicare, all of the tumors qualify as minor in size, so you should report 52224. But when you add up all five tumors the sum will be 2.5 cm, so you'll report 52235 to private carriers.

Tip: Double-check with your individual payers to determine their rules on reporting multiple bladder tumor removals.

Watch out: Don't be tempted into using modifier 22 (Unusual procedural services) or reporting more than one procedure code. You may consider these options because the physician does more work removing multiple tumors than he does when he removes just one.

The problem is that the CPT code descriptors for 52224-52240 state "tumor(s)" or "lesions(s)," meaning that each code represents single or multiple tumors of the same size. Answers to Reader Questions and You Be the Coder contributed by Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology, State University of New York, Stony Brook; and Morgan Hause, CCS, CCS-P, privacy and compliance officer for Urology of Indiana LLC, a 31-urologist practice in Indianapolis.