Urology Coding Alert

Question: I read the article titled, “3 Botox Scenarios Help You Navigate Your 52287 Claims” in the March 2014 (Vol. 16, No. 3) edition. The last section talks about fulguration of a bleeder at one of the injection sites. I spoke with one of our providers about this who said that he would use 52224 rather than 52214, based on location of the Botox injections. Is that code billable with Botox injection code 52287?

Oregon Subscriber

Answer: 

While you could report 52224 (Cystourethroscopy, with fulguration [including cryosurgery or laser surgery] or treatment of minor [less than 0.5 cm] lesion[s] with or without biopsy) with the Botox injection code 52287 (Cystourethroscopy, with injection[s] for chemodenervation of the bladder), that is not the correct coding for the scenario given in the article. In the article, the urologist performed Botox bladder injections, and the patient had bleeding from one of the injection sites. The provider then fulgurated the bleeding injection site. 

Code 52224 is for the fulguration/treatment of a minor bladder tumor. That is not the correct code for fulguration of a bleeder that resulted from a Botox injection. 52214 (Cystourethroscopy, with fulguration [including cryosurgery or laser surgery] of trigone, bladder neck, prostatic fossa, urethra, or periurethral glands) is the correct code for that, as noted in the March article. 

Helpful hint: When you fulgurate a bleeding vessel from radiation cystitis or bleeding vessels from hemorrhagic prostatitis, bill 52214 for that scenario as well.