Wiki Transurethral Resection of Previous Bladder Tumor Site?

toria11

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When the physicians takes another resection of a bladder tumor SITE, would that still be billed by size with 52224-52235? Or would it be more appropriate to bill 52204 since there is no tumor? It also isn't completely clear to be whether the fulguration was for hemostasis or not in this case. Your thoughts are appreciated!

POSTOPERATIVE DIAGNOSIS:
History of bladder cancer.

PROCEDURE PERFORMED:
Cystoscopy, transurethral resection of bladder tumor base, surface area 2 cm.

ANESTHESIA:
General.

ESTIMATED BLOOD LOSS:
Minimal.

INDICATIONS:
Please see the dictated H and P, but this is a 72-year-old female, who had significant volume of bladder tumor, underwent a cystoscopy and bladder tumor resection on 11/26. Final path was high-grade T1 disease, no muscle in the specimen. She is here for re-TUR to make sure she was not understaged.

DESCRIPTION OF PROCEDURE:
The patient was brought to the operating room. After general anesthesia was instituted by the anesthesiologist, the patient was put in dorsal lithotomy position and prepped and draped in the usual sterile fashion.

Using a 21-French cystoscope sheath, the bladder was entered via urethra. The bladder was examined with 30- and 70-degree lenses. The two tumor sites were noted. On both sides, there was some minimal papillary change on the fringe of the previous tumor resection, but no overt tumors were noted.

After this was completed, we switched to 24-French resectoscope sheath, which was entered with the obturator. The working port was added and using electrical loop electrocautery, we kind of brushed off some of the necrotic area that was sitting on the top of the tumor, the previous resection base. This was then Elliked out and was not sent for specimen. We then resected at the base until we got very deep without perforating and this was both on the posterior wall/floor and also on the right lateral wall. These were sent separately and the areas were cauterized with rollerball electrocautery. We had excellent hemostasis.

An 18-French Foley catheter inserted in the bladder via the urethra and balloon was inflated with 10 mL of sterile water. The patient was taken down from dorsal lithotomy position, extubated and taken to the recovery in stable condition.

I spoke with the patient and husband postoperatively. Urine was clear. I then went in to do another case and was called from that case because the patient started having significant bleeding. I inspected the catheter and instructed them that we might have to go back for a second look, but within approximately 20 to 30 minutes, it became clear. Catheter was irrigated with small amount of clots. Subsequently became clear, but decision was made to observe the patient overnight. It appears that the patient has significant bladder spasm resulting in the venous bleed, but this again cleared with time and hydration. AD 20211227
 
I would suggest 52234 for the 2 cm resection which is to look for more tumor not previously removed, deeper tumor. Diagnosis should be D49.4, "path pending." Bill 52204 if only a biopsy not a resection of the site was performed.
 
Indication for Surgery
bladder cancer

Preoperative Diagnosis
bladder cancer


Postoperative Diagnosis
same


Operation
CYSTOSCOPY with TRANSURETHRAL RESECTION BLADDER, large , 5 cm



Technique:
Preoperative antibiotics and general anesthesia was administered. A rigid cystoscope was placed in the urethra. The bladder was entered. A partially calcified tumor was seen posteriorly on the bladder near the midline. This was about 5 cm, did not appear very deep. Using a resectoscope the tumor was resected to completion. Deep resection with muscle was clearly obtained. The tumors were aspirated out with a toomey syringe and sent for permanent section. Hemostasis was obtained with loop cautery and was excellent. A 20Fr foley catheter was placed.





Please suggest CPT whether it is 52240 or 52235?
 
Indication for Surgery
bladder cancer

Preoperative Diagnosis
bladder cancer


Postoperative Diagnosis
same


Operation
CYSTOSCOPY with TRANSURETHRAL RESECTION BLADDER, large , 5 cm



Technique:
Preoperative antibiotics and general anesthesia was administered. A rigid cystoscope was placed in the urethra. The bladder was entered. A partially calcified tumor was seen posteriorly on the bladder near the midline. This was about 5 cm, did not appear very deep. Using a resectoscope the tumor was resected to completion. Deep resection with muscle was clearly obtained. The tumors were aspirated out with a toomey syringe and sent for permanent section. Hemostasis was obtained with loop cautery and was excellent. A 20Fr foley catheter was placed.





Please suggest CPT whether it is 52240 or 52235?
I would suggest 52235 for 5cm. I use 52240 for larger than 5cm.
 
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