may 2010

Resection of Bladder Tumors

1. Many times with cystourethroscopy procedures coding can be determined by whether you are reporting based on Medicare guidelines or by AMA guidelines, but with clarification by CPT Assistant in August 2009, resection of bladder tumors would be reported the same way regardless of which guidelines you are following.  The CPT Assistant article reads “Codes 52234-52240 should only be reported once, regardless of the number of tumors removed. 
   ONLY ONE OF THE THREE CODES MAY BE REPORTED PER SESSION”. 
   
   Select the code based on the largest tumor. 

   For example, if 3 small tumors and one large tumor were removed – only CPT code 52240 (Large bladder tumor(s)) would be reported.  The CCI edits also bundle the small and medium tumors into the large tumor code 52240 and it would be inappropriate to append modifiers for the purpose of unbundling these procedures.