Wiki Is 52204 included with 52260

[Robbin109]

Does CPT 52260 included the biopsy work of 52204?

Thanks!

 

[Mconway03]

Code 52204 is a component of code 52260 but a modifier is allowed in order to differentiate between the services provided. If you bill these two services together than the 59 modifier would have to be on 52204. Even though 52204 has a higher RUV, CCI states that it is apart of 52260.

 

[Robbin109]

If it is a componet of 52260, in which circumstance would you override the edit?

Thanks!


Sorry, Urology isn't my speciality

 

[OCD_coder]

The 52204 (RVU 2.59) would have to occur at a separate session for a new problem or indication that presented after the patient had left the OR.

Mconway03 is correct, when these codes bundle and are performed at the same surgical session you would only code the 52260 (RVU 3.91).

http://www.cms.gov/Outreach-and-Edu...k-MLN/MLNMattersArticles/Downloads/SE1418.pdf
Revised: June 2, 2014