TURBT CPT Code (2022) Description, Guidelines, Reimbursement, Modifiers & Example

TURBT CPT code (Transurethral Resection of Bladder Tumor) 52234, 52235, or 52240 bills for when the Physician performs Cystourethroscopy with fulguration (including cryosurgery or laser surgery) and or resection of a small, medium, or large bladder tumor from 0.5 cm to greater than 5 cm. Bladder surgery uses a scope (Cystourethroscopy) to remove abnormal tissue by applying an electrical current.

TURBT CPT Code Description

The following are the reason when the Physician performs 52234, 52235, or 52240:

To alleviate the symptoms of enlarged prostate
Unable to urinate because of prostate cancer
Difficulty emptying your bladder
Recurrent urinary tract infections
To cater to the bladder control issues due to enlarged prostate
Bleeding from the prostate
Bladder stones with prostate enlargement
Particularly slow urination
To lower the harm to kidneys when the patient is unable to urinate
Frequent urination in the night

The Physician visualizes the whole urinary system via a cystourethroscope, incorporates from the urethra and bladder, and removes bladder tumors by electric current (fulguration) or excision.

The Physician then inserts an instrument via the endoscope to eradicate or destroy the bladders tumor by the excision or electric current (fulguration). The Physician ma uses chemicals to obliterate the lesions, such as liquid nitrogen or carbon dioxide (cryosurgery) or lasers to destroy lesions.

At the end of the procedure, the Physician removes all the instruments, including the cystourethroscope. TURBT CPT code 52234 appropriates when the Physician removes the small tumor(s) 0.5 up to 2 cm in size. For medium bladder tumor(s) 2 to 5 cm, report 52235. For large tumor(s) larger than 5 cm, report 52240.

CPT 52234

CPT 52234 bills for the service when the Physician performs Cystourethroscopy with fulguration (including cryosurgery or laser surgery) and or resection of SMALL bladder tumor(s) (0.5 up to 2.0 cm).

CPT 52235

TURBT CPT code 52235 bills for the service when the Physician performs Cystourethroscopy with fulguration (including cryosurgery or laser surgery) and or resection of MEDIUM bladder tumor(s) (2.0 to 5.0 cm).

CPT 52240

CPT 52240 bills for the service when the Physician performs Cystourethroscopy with fulguration (including cryosurgery or laser surgery) and or resection of LARGE bladder tumor(s).

TURBT CPT Code Billing Guidelines

Documentation should support the medical necessity of service. It reflects that service is medically necessary and appropriate.

If the Physician spends extra time in addition to the usual procedure time, it is appropriate to append modifier 22 with the submission of the operative report and cover letter.

TURBT CPT code 52234, 52235, or 52240 includes diagnostic and therapeutic endoscopy bowel segments utilized as replacements for the native bladder.

If the Physician performs the minor fulguration of the bladder in the procedure, it is appropriate to report with CPT 52224.

If the Physician creates an incision in the bladder and performs the excision of the bladder tumor, It is appropriate to report with 51530.

If the Physician performs the treatment of lesions by insertion of a radioactive substance, It is appropriate to report with 52250.

If the Physician performs the fulguration or cryosurgical destruction of bladder lesions through an incision, it is appropriate to report with TURBT CPT code(s) 51020-51030.

HCPCS level II codes may report in addition to CPT 52234, 52235, or 52240 if the Physician uses any supplies when the procedure performs. Check the appropriate payer guidelines if covered or not.

TURBT CPT Code Modifiers

The following are the list modifiers applicable with TURBT CPT code 52234, 52235, or 52240 :

22, 23, 47, 51, 52, 53, 54, 55, 56, 58, 59, 62, 63, 76, 77, 78, 79, 80, 81 82, 99, , AS, CC, CR, ET, EY, GA, GC, GK, GR, GU, GY, GZ, KX, Q5, Q6, QJ, SG, TC, XR, XP, XU, XS, AI, AQ, AR.

Modifier 47 is applicable CPT 52234, 52235, or 52240 when the surgeon administers general or regional anesthesia to the patient. It is not appropriate to report modifier 47 with anesthesia procedures.

Modifier 76 is appropriate with CPT 52234, 52235, or 52240 when a similar service performs by the Same Physician on the same day.

Modifier 54 is applicable with CPT 52234, 52235, or 52240 when the Physician provides surgical care only. In contrast, Modifiers 55 and 56 attach to CPT 52234, 52235, or 52240 when the Physician performs post-management and pre-operative care only.

Modifier 77 is applicable with TURBT CPT code 52234, 52235, or 52240 when a similar service performs by a different Physician on the same service date.

Modifier 59 is applicable with CPT 52234, 52235, or 52240 when a Distinct service performs by the Physician and bundles with another procedure on the same date.

Modifier X {E, P, S, U} is applicable instead of Modifier 59 with CPT 52234, 52235, or 52240 when service bills to Medicare insurance. It divides the modifier into four parts for further specification of the procedure.

Modifier 53 will be reported with CPT 52234, 52235, or 52240 if an unsuccessful attempt for the TURP makes due to unavoidable circumstances like allergic reactions to the substance.

Modifier 22 applies to CPT 52234, 52235, or 52240 when services perform longer than usual and take extra resources during the procedure.

Modifier 23 is applicable with CPT 52234, 52235, or 52240 when general or local anesthesia administers by the Physician and routinely does not require during the procedure.

Modifier 52 applies when the Physician does not provide complete TURP service and terminates due to unavoidable circumstances.

If physicians believe that Medicare will deny such service, reporting with a GA modifier is appropriate. The beneficiary must sign an Advance Beneficiary Notification (ABN), and CPT 52234, 52235, or 52240 must apply the GA modifier to that service.

TURBT CPT Code Reimbursement

A maximum of one unit can be a bill on the same service date of TURBT CPT code 52234, 52235, or 52240. In contrast, the Two units allow documentation supporting the service’s medical necessity.

The cost and RUVS of CPT 52234 are $261.52 and 7.55693 when performed in the facility. In contrast, the reimbursement and RUVS of CPT 52234 are $261.52 and 7.55693when furnished in the non-facility.

The cost and RUVS of CPT 52235 are $306.22 and 8.84867 when performed in the facility. In contrast, the reimbursement and RUVS of CPT 52235 are $306.22 and 8.84867 when performed in the non-facility.

The cost and RUVS of CPT 52240 are $415.94 and 12.01930 when performed in the facility. In contrast, the reimbursement and RUVS of CPT 52240 are $415.94 and 12.01930 when performed in the non-facility.

TURBT CPT Code Examples

The following are the examples when 52234, 52235, or 52240 bills:

Example 1

A 17-year-old male presents to the office for urinary symptoms. He has had prostate cancer since 2018 and is currently on chemotherapy for cancer.

The patient denies any recent travel, dizziness, nausea, vomiting, extremity swelling, headache, numbness, chest pain, shortness of breath, and urinary problem.