Is this Biopsy Mistake Costing Your Urology Practice $400 Per Claim?
Posted on 24. Feb, 2009 by Editor in Hot Coding Topics
Tip: Look beyond the term ‘fulguration’ when you choose your codes.
If you slap 52204 on every cystoscopic bladder biopsy with fulguration that your urologist performs, you could be missing out on almost $400 per procedure. The clues to which bladder biopsy code you should be using lie within your urologist’s documentation.
Myth: Code 52204 (Cystourethroscopy, with biopsy[s]) is the only code you can use to report a cystoscopic bladder biopsy and fulguration.
Fact: Which bladder biopsy code you report depends on the reason for the fulguration and the information your urologist provides in his operative report. You will then choose from the following bladder biopsy codes:
• 52204 — Cystourethroscopy, with biopsy(s)
• 52224 — Cystourethroscopy, with fulguration (including cryosurgery or laser surgery) or treatment of MINOR (less than 0.5 cm) lesion(s) with or without biopsy
• 52234 — Cystourethroscopy, with fulguration (including cryosurgery or laser surgery) and/or resection of; SMALL bladder tumor(s) (0.5 up to 2.0 cm)
• 52235 — … MEDIUM bladder tumor(s) (2.0 to 5.0 cm)
• 52240 — … LARGE bladder tumor(s)
If the urologist did a biopsy and fulgurated a bleeder within the biopsy site without treatment of a lesion, you should only report 52204, as this code also includes the fulguration. “If fulguration is used only to stop bleeding from the biopsy site, it’s included in the biopsy and you would bill 52204,” explains Elizabeth Hollingshead, CPC, CMC, corporate billing/coding manager of Northwest Columbus Urology Inc. in Marysville, Ohio.
On the other hand, if you’re “treating” a small lesion less than 0.5 cm in size with biopsy and...
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