Wiki Cystourethroscopy with Botox injections with fulguration of bleeding

[Bernadette10]

Can anything be coded for the fulguration of the oozing in the bladder wall after the injections? It seems like there was extra work done, but I didn't find anything except 52287 that would fit.

Diagnosis: OAB (overactive bladder)

CYSTOSCOPY, BLADDER BOTOX INJECTIONS, BLADDER FULGURATION
A rigid cystoscope was introduced per urethra and passed into the bladder under direct vision. The urethra and bladder were thoroughly examined with findings as noted below. 100U of Botox was injected in 20 equal aliquots of 0.5ml into the detrusor muscle. Care was taken to avoid blood vessels and the ureteral orifices.

Once the injections were completed the entire bladder was inspected. There was 1 injection site on the posterior wall that was oozing and did not respond to pressure. Therefore, I decided to fulgurate this area with a Bugbee electrode. Once this was completed hemostasis was excellent and there was no bleeding in the bladder.

 

[julieordway]

In this case, you would bill 52287 AND 52214 (Cystourethroscopy, with fulguration (including cryosurgery or laser surgery) of trigone, bladder neck, prostatic fossa, urethra, or periurethral glands). You won't hit up against any bundling edits coding these two codes together. CPT 52287 only includes utilizing the cystoscope to examine the interior structures and injecting the botox into the muscle. CPT 52214 would cover the fulguration portion of the procedure.

 

[Bernadette10]

Another coder disagrees and says the fulguration of bleeding is included in the injection procedure since the fulguration was only for control of bleeding, but thanks for your thoughts.

"No, it is not appropriate to code for the fulguration of the surgical site immediately following the injection. The NCCI manual chapter 9, section I-9 states, "Control of bleeding during an operative procedure is an integral component of a surgical procedure and is not separately reportable. Postoperative control of bleeding not requiring a return to the operating room is included in the global surgical package and is not separately reportable. However, control of bleeding requiring return to the operating room in the postoperative period is separately reportable using modifier 78."

 

[csperoni]

I'm not certain I agree with coding 52214 in this case. It seems like the bleeding was caused by the procedure the provider was doing. So the provider needed to do additional work due to a situation they caused. Similar to if surgeon inadvertently nicked bowel serosa during a surgery. Evaluates and decides no significant injury, but decides to put a suture or 2 just to be safe. You would not bill for that additional work.
Even if billable, 52214 might be an overvalue of the additional work needed as it is valued almost twice as much as 52287.
I personally would consider the additional work in this case a situation caused by the procedure being performed. If the physician or documentation indicate otherwise, I would then consider -22 on 52287.