Urology Coding Alert

Question: Which diagnosis code should I link to biopsies of normal-appearing bladder tissue? The urologist resected a malignant transitional cell carcinoma of the bladder during the same patient encounter.

Maine Subscriber

Answer: In addition to tumor resection, your question indicates that your urologist performed bladder biopsies, 52204 (Cystourethroscopy, with biopsy), of the normal-appearing bladder mucosa because he or she suspected carcinoma in situ.
 
Use a code from the 52234-52240 series (Cystourethroscopy ...) for the resection of the bladder tumor basing your choice on tumor size, and add 52204-59 (Distinct procedural service) for the biopsies of sites other than that of the resected tumor.
 
Link ICD-9 Codes 239.4 (Neoplasms of unspecified nature, bladder) or 188.0-188.9 (Malignant neoplasm of bladder) to the appropriate transurethral resection code (52234-52240). Use 239.4 if you are unsure of the tumor's nature, or use the 188.x series if you are convinced the tumor is malignant.
 
Most urologists with endoscopic experience will be able to delineate malignancy on the tumor's cystoscopic appearance and consequently may use the ICD-9 Codes for malignant bladder tumors.
 
Choose the appropriate code from the following list depending on the documented location of the tumor:
   188.0 - Trigone of urinary bladder
   188.1 - Dome of urinary bladder
   188.2 - Lateral wall of urinary bladder
   188.3 - Anterior wall of urinary bladder
   188.4 - Posterior wall of urinary bladder
   188.5 - Bladder neck
   188.6 - Ureteric orifice
   188.7 - Urachus
   188.8 - Other specified sites of bladder
   188.9 - Bladder, part unspecified.   When coding for bladder biopsies, use V71.89 (Observation and evaluation for other specified suspected conditions; other specified suspected conditions) if you code the service prior to pathologic confirmation or if the pathology report is negative. Report 233.7 (Carcinoma in situ, bladder) if the pathology is positive.