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Urology Coding Alert

Reader Questions:

Use -59 With Biopsies and No History of Bladder Tumors

Published on Sun Dec 01, 2002

Question: Which code should I use for bladder biopsies and fulguration of bladder biopsy sites? The doctor did not mention a lesion but only a history of bladder tumors. New Jersey Subscriber

Answer: From your brief description, it appears your urologist did biopsies of normal mucosa to map the bladder for possible carcinoma in situ. If this is in fact the case, use code 52204 (Cystourethroscopy, with biopsy). This includes the fulguration. Remember to code each biopsy site taken and send each specimen in a separate container indicating the areas biopsied. You would need codes 52204, 52204-59 (Distinct procedural service) and 52204-59. Use a new line for each biopsy. For some commercial carriers and HMOs, you many need to use one line with the number of biopsies indicated in the unit column of form 1500.

Medicare has been known to pay for several but not all biopsies. Some private carriers will only pay for one. Therefore, you should bill as shown above and ask the carriers how they would like this scenario billed.    
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