How To Use CPT Code 52250

CPT 52250 describes a specific procedure involving the insertion of a radioactive substance during cystourethroscopy. This article will cover the description, official details, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 52250?

CPT 52250 is a code used to describe a procedure that involves the insertion of a radioactive substance during cystourethroscopy. This procedure allows the healthcare provider to inspect the urethra, prostatic urethra (in men), the interior of the bladder, and ureteric openings using a cystoscope. The provider may also perform a biopsy or fulguration of suspicious lesions for further examination.

2. Official Description

The official description of CPT code 52250 is: ‘Cystourethroscopy with insertion of radioactive substance, with or without biopsy or fulguration.’

3. Procedure

1. The patient is appropriately prepped and anesthetized, which may involve instilling anesthetizing gel into the urethra and/or sedating the patient.
2. The healthcare provider inserts a cystoscope into the urethra and slowly advances it into the bladder, inspecting the urethra and lining of the bladder.
3. Sterile saline water may be injected into the bladder to improve the view of the bladder wall.
4. The provider then inserts a radioactive substance through the cystoscope to treat cancerous tissue.
5. If any suspicious lesions are identified, the provider may perform a biopsy or fulguration, removing a portion or entirety of the tissue for further examination or using high-frequency electric currents to destroy unhealthy tissue.
6. Once the procedure is complete, the instruments and scope are removed, and the bladder is drained.

4. Qualifying circumstances

CPT 52250 is typically performed on patients with suspected or diagnosed cancer in the urethra, prostatic urethra, or bladder. The procedure is carried out by a healthcare provider who is trained in cystourethroscopy and the use of radioactive substances. The decision to perform a biopsy or fulguration depends on the presence of suspicious lesions that require further examination or treatment.

5. When to use CPT code 52250

CPT code 52250 should be used when a healthcare provider performs cystourethroscopy and inserts a radioactive substance during the procedure. This code may be used with or without the additional procedures of biopsy or fulguration. It is important to accurately document the specific details of the procedure to support the use of this code.

6. Documentation requirements

To support a claim for CPT 52250, the healthcare provider must document the following information:

• Patient’s diagnosis and the need for cystourethroscopy with insertion of a radioactive substance
• Details of the procedure, including the use of a cystoscope, insertion of the radioactive substance, and any additional procedures such as biopsy or fulguration
• Date and duration of the procedure
• Findings during the procedure, including any suspicious lesions
• Any additional treatments or interventions performed
• Signature of the healthcare provider performing the procedure

7. Billing guidelines

When billing for CPT 52250, ensure that the procedure meets the specific criteria outlined in the code description. It is important to accurately document the details of the procedure to support the billing. Additionally, be aware of any specific guidelines or requirements from insurance providers or payers. It is also important to consider any applicable modifiers that may be required for proper billing.

8. Historical information

CPT 52250 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates or changes to the code since its addition.

9. Examples

1. A healthcare provider performs cystourethroscopy with the insertion of a radioactive substance to treat bladder cancer in a patient.
2. During cystourethroscopy, a suspicious lesion is identified, and the provider performs a biopsy and inserts a radioactive substance for further treatment in a patient with suspected urethral cancer.
3. A healthcare provider performs cystourethroscopy with the insertion of a radioactive substance to treat prostatic urethral cancer in a male patient.
4. During cystourethroscopy, the provider identifies suspicious lesions in the bladder and performs fulguration using a radioactive substance for a patient with bladder cancer.
5. A healthcare provider performs cystourethroscopy with the insertion of a radioactive substance to treat a recurrent tumor in the urethra of a patient.
6. During cystourethroscopy, the provider identifies a suspicious lesion in the bladder and performs a biopsy using a radioactive substance for a patient with suspected bladder cancer.
7. A healthcare provider performs cystourethroscopy with the insertion of a radioactive substance to treat a recurrent tumor in the prostatic urethra of a male patient.
8. During cystourethroscopy, the provider identifies suspicious lesions in the bladder and performs fulguration using a radioactive substance for a patient with a history of bladder cancer.
9. A healthcare provider performs cystourethroscopy with the insertion of a radioactive substance to treat a tumor in the urethra of a female patient.