Charlene Posted Wed 22nd of May, 2019 21:48:43 PM
My question relates to the article, "Remember These Guidelines When Coding Cystoscopy with Bladder Tumor Resection" in the May 2019, Vol. 21, No. 5 Urology Newsletter. Example 1 says a 5 cm tumor for Medicare would be coded 52240, and example 3 says to code 52240 for private carriers when tumors add up to 5 cm. Why wouldn't 52235 be the correct code in these scenarios since the code's descriptive size is 2.0 to 5.0 cm? It seems to me if the tumor(s) size is 5.1 and larger the correct code would be 52240. Also, I have never understood why the size range for 52235 does not begin with 2.1. If a tumor is 2 cm, what coder wouldn't apply the higher valued 52235 over 52234?
SuperCoder Answered Thu 23rd of May, 2019 09:01:20 AM
SuperCoder Answered Thu 23rd of May, 2019 09:01:33 AM
Our team is working on your query and will reply you soon.
SuperCoder Answered Fri 24th of May, 2019 07:50:12 AM
Thank you for your patience.
As per the information provided by you, it is appropriate to use 52235 for tumor which have the size up to 5 cm.
As the article dates back to 2002 almost 17 years, there might be some errors, kindly overlook the information in the article and please go through with information provided in the below mentioned link regarding cystourethroscopy with fulguration and bladder tumor resections.
Code 52235 Cystourethroscopy, with fulguration (including cryosurgery or laser surgery) and/or resection of; MEDIUM bladder tumor(s) (2.0 to 5.0 cm). The descriptor suggest 2.0 to 5.0 cm therefore size of the tumor would be counted up to 5.0 cm.
It is also correct that if the tumor(s) size is 5.1 and larger then code 52240 will be appropriate to use.
Hope this helps.