How To Use CPT Code 52204

CPT 52204 describes a specific procedure known as cystourethroscopy with biopsy(s). This article will provide an overview of the code, including its official description, the procedure itself, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information, and examples of when CPT 52204 may be used.

1. What is CPT Code 52204?

CPT 52204 is a code used to describe the procedure of cystourethroscopy with biopsy(s). It involves the use of a cystoscope, a lighted tubular instrument, to inspect the urethra, prostatic urethra (in men), the interior of the bladder, and ureteric openings. During this procedure, the provider may also take biopsies of suspicious tissue through the cystoscope.

2. Official Description

The official description of CPT code 52204 is: ‘Cystourethroscopy, with biopsy(s).’ This code encompasses the use of a cystoscope to examine the urethra, prostatic urethra (in men), bladder, and ureteric openings, as well as the collection of biopsies through the cystoscope.

3. Procedure

1. With the patient appropriately prepped and anesthetized, the provider inserts the cystoscope into the urethra and slowly advances it into the bladder.
2. Using the camera attached to the cystoscope, the provider examines the urethra, bladder, and ureteric openings, and may inject sterile saline water into the bladder to improve visibility.
3. If any suspicious lesions are identified, the provider can use specialized instruments inserted through the cystoscope to take biopsies of the tissue.
4. Once the procedure is complete, the provider removes the instruments and cystoscope and drains the bladder.

4. Qualifying circumstances

CPT 52204 is typically performed when there is a need to visually inspect the urethra, prostatic urethra (in men), bladder, and ureteric openings, and when biopsies of suspicious tissue are required. This procedure may be performed for various reasons, such as diagnosing urinary tract infections, evaluating bladder cancer treatment, or assessing conditions like stress incontinence. It is important to note that the procedure should be performed by a qualified healthcare professional.

5. When to use CPT code 52204

CPT code 52204 should be used when a cystourethroscopy procedure with biopsies is performed. It is important to ensure that the procedure meets the specific criteria outlined in the code description. This code should not be used for other types of cystourethroscopy procedures that do not involve biopsies.

6. Documentation requirements

When reporting CPT code 52204, the following documentation should be included:

• Reason for the procedure and the need for biopsies
• Details of the cystourethroscopy procedure, including the specific areas examined
• Any findings or abnormalities observed during the procedure
• Documentation of the biopsies taken, including the number and location
• Any additional procedures or interventions performed during the same session
• Signature of the performing healthcare professional

7. Billing guidelines

When billing for CPT code 52204, it is important to ensure that the procedure meets the specific criteria outlined in the code description. This includes the use of a cystoscope for inspection and the collection of biopsies. It is also important to follow any additional guidelines provided by payers or coding authorities. CPT code 52204 should not be reported with other codes that describe different procedures or services.

8. Historical information

CPT code 52204 was added to the Current Procedural Terminology system on January 1, 1990. There was a code change on January 1, 2007, which resulted in the current code description.

9. Examples

1. A patient undergoes cystourethroscopy with biopsies to evaluate recurring urinary tract infections.
2. A provider performs cystourethroscopy with biopsies to assess the effectiveness of bladder cancer treatment.
3. A patient with suspected stress incontinence undergoes cystourethroscopy with biopsies to determine the underlying cause.
4. A provider performs cystourethroscopy with biopsies to investigate abnormal findings on a previous imaging study.
5. A patient undergoes cystourethroscopy with biopsies as part of a follow-up examination after bladder surgery.
6. A provider performs cystourethroscopy with biopsies to evaluate the presence of abnormal cells in the bladder.
7. A patient with recurring urinary symptoms undergoes cystourethroscopy with biopsies to rule out bladder abnormalities.
8. A provider performs cystourethroscopy with biopsies to assess the extent of inflammation in the urethra and bladder.
9. A patient with suspected bladder stones undergoes cystourethroscopy with biopsies to confirm the diagnosis.
10. A provider performs cystourethroscopy with biopsies to investigate the cause of persistent hematuria (blood in the urine).