I am looking for guidance on a CPT code to use for the transurethral resection of necrotic bladder mass that our urology oncologist performed. Any help is very much appreciated. Can a TURBT 52240 be used for this along with 52332 and 74420-26?
POSTPROCEDURE DIAGNOSIS: Bladder tumor
OPERATIVE PROCEDURE:
Transurethral resection of bladder tumor, large
Left retrograde pyelogram
Left 6 x 24 double-J ureteral stent placement
Examination under anesthesia
SPECIMENS:
1. Left lateral wall bladder tumor, large
FINDINGS:
1. Anterior urethra is unremarkable. Posterior urethra revealed a high riding bladder neck with a small prostatic urethra without any significant obstruction. No foreign bodies or any stones present within the patient's bladder. The right ureteral orifice was identified was unremarkable. Patient had a large nodular mass on the left lateral bladder wall the superficial portion of the mass was fairly necrotic tissue. This laid over the left ureteral orifice. The mass was completely resected. The left ureteral orifice was not resected due to his close proximity to the ureteral orifice a 6 x 24 double-J ureteral stent was placed.
2. Left retrograde pyelogram revealed normal caliber left collecting system without any filling defects.
3. Examination under anesthesia revealed a small prostate without any nodularity. There were no 3-dimensional masses on the patient's bladder and his bladder was mobile.
4. Patient had a lesion on the dorsal aspect of the head of the penis adjacent to the coronal sulcus concerning for squamous cell carcinoma.
INDICATIONS FOR PROCEDURE:
91-year-old gentleman presented with gross hematuria CT scan in July 2023 revealed a large nodular lesion on the left lateral bladder wall. He was recommended to undergo transurethral section of bladder tumor with examination under anesthesia. The risks, benefits, alternatives of the procedure were described to the patient in detail and agreed to proceed.
DESCRIPTION OF PROCEDURE:
After informed consent was obtained, the patient was brought to the operative suite. He was sedated by anesthesia. He was intubated with an GETA. He was prepped and draped in sterile fashion. A surgical time-out was performed for identification of the patient, procedure and assure that appropriate preoperative antibiotics were administered. Patient's urethra was intubated with a 22 French rigid cystourethroscope with a 30-degree lens. The anterior urethra was unremarkable. Posterior urethra showed a small prostatic urethra with a high riding bladder neck. Once I was within his bladder, his bladder was systemically evaluated with a 70/30-degree lens. There were no foreign bodies or any stones present. The right ureteral orifice was identified and was unremarkable. The patient had a large nodular lesion emanating from the left lateral wall of the superficial portion of the lesion lies and necrotic. The mass isolated over the left ureteral orifice. I then remove the cystourethroscope and calibrated the patient's urethra up to 28 French. A 26 French continuous flow resectoscope was then inserted within the patient's bladder. Using the monopolar electrocautery cutting loop I resected the large tumor in its entirety down to the level of the muscle layer of the bladder. At the conclusion of the resection the resection chips were all evacuated from the bladder. The rollerball was used to fulgurate the base of the resection site. The resection area was in close proximity to the left ureteral orifice. Because of this, I decided to place a left ureteral stent. The resectoscope was removed and a 22 French rigid cystoscopy with a 30-degree lens was inserted within the patient's bladder. I then cannulated the patient's left ureteral orifice with a 0.035 inch sensor wire and this was advanced up to the left collecting system under fluoroscopic guidance. An open-ended catheter was passed over the wire and a left retrograde pyelogram was shot. This revealed a normal caliber left collecting system without any defects. The wire was then reinserted within the left collecting system and a 6 x 24 double-J ureteral stent was placed. Adequate curl was seen within the left collecting system with fluoroscopy. At that point I then systemically evaluated the patient’s bladder and there was no signs of any residual tumor. There was no active bleeding noted. I then removed the cystourethroscope and placed a 20 French three-way Foley catheter. He was started on continuous bladder irrigation. The catheter was hand irrigated until retrieved clear irrigant. An examination under anesthesia was then performed which revealed a small prostate without any nodularity. There were no 3-dimensional masses on the patient's bladder and his bladder was mobile. The patient did have a lesion at the dorsal aspect of the glans adjacent to the coronal sulcus concerning for squamous cell carcinoma of the penis. His anesthesia was then reversed, he was extubated, and transported back to the PACU in stable condition.
POSTPROCEDURE DIAGNOSIS: Bladder tumor
OPERATIVE PROCEDURE:
Transurethral resection of bladder tumor, large
Left retrograde pyelogram
Left 6 x 24 double-J ureteral stent placement
Examination under anesthesia
SPECIMENS:
1. Left lateral wall bladder tumor, large
FINDINGS:
1. Anterior urethra is unremarkable. Posterior urethra revealed a high riding bladder neck with a small prostatic urethra without any significant obstruction. No foreign bodies or any stones present within the patient's bladder. The right ureteral orifice was identified was unremarkable. Patient had a large nodular mass on the left lateral bladder wall the superficial portion of the mass was fairly necrotic tissue. This laid over the left ureteral orifice. The mass was completely resected. The left ureteral orifice was not resected due to his close proximity to the ureteral orifice a 6 x 24 double-J ureteral stent was placed.
2. Left retrograde pyelogram revealed normal caliber left collecting system without any filling defects.
3. Examination under anesthesia revealed a small prostate without any nodularity. There were no 3-dimensional masses on the patient's bladder and his bladder was mobile.
4. Patient had a lesion on the dorsal aspect of the head of the penis adjacent to the coronal sulcus concerning for squamous cell carcinoma.
INDICATIONS FOR PROCEDURE:
91-year-old gentleman presented with gross hematuria CT scan in July 2023 revealed a large nodular lesion on the left lateral bladder wall. He was recommended to undergo transurethral section of bladder tumor with examination under anesthesia. The risks, benefits, alternatives of the procedure were described to the patient in detail and agreed to proceed.
DESCRIPTION OF PROCEDURE:
After informed consent was obtained, the patient was brought to the operative suite. He was sedated by anesthesia. He was intubated with an GETA. He was prepped and draped in sterile fashion. A surgical time-out was performed for identification of the patient, procedure and assure that appropriate preoperative antibiotics were administered. Patient's urethra was intubated with a 22 French rigid cystourethroscope with a 30-degree lens. The anterior urethra was unremarkable. Posterior urethra showed a small prostatic urethra with a high riding bladder neck. Once I was within his bladder, his bladder was systemically evaluated with a 70/30-degree lens. There were no foreign bodies or any stones present. The right ureteral orifice was identified and was unremarkable. The patient had a large nodular lesion emanating from the left lateral wall of the superficial portion of the lesion lies and necrotic. The mass isolated over the left ureteral orifice. I then remove the cystourethroscope and calibrated the patient's urethra up to 28 French. A 26 French continuous flow resectoscope was then inserted within the patient's bladder. Using the monopolar electrocautery cutting loop I resected the large tumor in its entirety down to the level of the muscle layer of the bladder. At the conclusion of the resection the resection chips were all evacuated from the bladder. The rollerball was used to fulgurate the base of the resection site. The resection area was in close proximity to the left ureteral orifice. Because of this, I decided to place a left ureteral stent. The resectoscope was removed and a 22 French rigid cystoscopy with a 30-degree lens was inserted within the patient's bladder. I then cannulated the patient's left ureteral orifice with a 0.035 inch sensor wire and this was advanced up to the left collecting system under fluoroscopic guidance. An open-ended catheter was passed over the wire and a left retrograde pyelogram was shot. This revealed a normal caliber left collecting system without any defects. The wire was then reinserted within the left collecting system and a 6 x 24 double-J ureteral stent was placed. Adequate curl was seen within the left collecting system with fluoroscopy. At that point I then systemically evaluated the patient’s bladder and there was no signs of any residual tumor. There was no active bleeding noted. I then removed the cystourethroscope and placed a 20 French three-way Foley catheter. He was started on continuous bladder irrigation. The catheter was hand irrigated until retrieved clear irrigant. An examination under anesthesia was then performed which revealed a small prostate without any nodularity. There were no 3-dimensional masses on the patient's bladder and his bladder was mobile. The patient did have a lesion at the dorsal aspect of the glans adjacent to the coronal sulcus concerning for squamous cell carcinoma of the penis. His anesthesia was then reversed, he was extubated, and transported back to the PACU in stable condition.