Is there a combo or a more inclusive cpt code that has: bladder tumor resection (2.5cm), cysto, ureteroscope, lithotripsy, and JJ stent placement?
NCCI bundles 52235 into 52356 for more extensive procedure.
Pt had a ureter stone and a bladder tumor.
Since it was all done by the same doc, same procedure it can't be bundled.
Would 52355 be more appropriate?
This is a complex scenario involving multiple procedures. Let's break it down and consider the most appropriate coding:
1. Bladder tumor resection (2.5cm): 52235 (Cystourethroscopy, with fulguration and/or resection of; medium bladder tumor(s) (2.0 to 5.0 cm))
2. Cystoscopy: This is included in the more extensive procedures
3. Ureteroscopy with lithotripsy and JJ stent placement: 52356 (Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with lithotripsy including insertion of indwelling ureteral stent)
You're correct that according to NCCI (National Correct Coding Initiative) edits, 52235 is bundled into 52356. This means that 52356 is considered the more extensive procedure and would typically be the only code reported.
However, in this case, we have two distinct issues being addressed: a bladder tumor and a ureteral stone. These are separate problems in different anatomical locations.
Given this situation, it would be appropriate to use both codes with a modifier to indicate that these were separate and distinct procedures:
52356 (Primary procedure)
52235-59 (Distinct procedural service)
The -59 modifier indicates that this is a distinct procedure from the primary code and should be separately reimbursed.
Regarding your question about 52355 (Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with resection of ureteral or renal pelvic tumor), this code would not be appropriate in this case because it describes resection of a ureteral or renal pelvic tumor, not a bladder tumor or ureteral stone.
To summarize, the most appropriate coding for this scenario would be:
52356
52235-59
As always, it's important to ensure that the operative report clearly documents all procedures performed and the medical necessity for each. If you're unsure, it's always best to consult with a certified medical coder or the payer for guidance on complex cases like this.
