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bladder tumor excision/fulgeration

Jennifer Posted Tue 10th of March, 2015 15:04:51 PM

I know with Medicare, you have to choose the largest bladder tumor to code excision/fulgeration- but where does Medicaid stand on this ? Thanks !(from Michigan)

SuperCoder Answered Wed 11th of March, 2015 07:00:22 AM

Hi Jennifer,
We are working on it according to Michigan policies.

Please bear with us.

Thank you

SuperCoder Answered Wed 11th of March, 2015 07:28:32 AM

We are researching into this topic. Thank you.

SuperCoder Answered Wed 11th of March, 2015 07:28:32 AM
Researching into this.
SuperCoder Answered Thu 12th of March, 2015 02:31:07 AM

For Medicare cases, the physician should bill the code that accurately reflects the largest lesion treated.
For Private Payers, the physicians should sum up the size of all lesions treated, and bill the code that most closely describes the
aggregate lesion size.
Payer policies will vary and should be verified prior to treatment for limitations on diagnosis, coding or site of service requirements. Medicaid policies vary from one state to another. However Medicaid typically follows Medicare rules. Please check with the payer if there is any specific coding regulation regarding TURBT procedures. You can also refer to Michigan state Medicaid website for more details:

http://www.michigan.gov/mdch/0,4612,7-132-2943_4860---,00.html

http://www.mdch.state.mi.us/dch-medicaid/manuals/MichiganStatePlan/MichiganStatePlan.pdf

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