UCR 253: Complex Bladder Clot Evacuation Coding and How to Bill Pre-Surgical E/M Services

August 1, 2025 

In this episode, Scott, Mark, and Ray answer coding questions submitted through the PRS Helpdesk. 

1. Pay er: Anthem BCBS
   State: NV
   Code/Codes: Tranurethral resection of bladder clot that was organized to facilitate removal
   Catagory: Other

   Question: I'm looking for a CPT code for : transurethral resection of bladder clot that was organized t facilitate removal Pt was inpt and Dr tried to do a clot removal from the bladder, but was unsuccessful as the whole bladder was the clot. So he used a resectoscope to resect the clot into smaller pieces and then removed them with a ridid biopsy forceps. This procedure took over 2 hours. I need help with a CPT code that will accurately describe this procedure

2. Payer: N/A
   State: TX
   Code/Codes: N/A
   Catagory: Other

   Question: Do you have info or prior podcast on billing for updated h/p prior to surgery if prior h/p done greater than 30 days before surgery? Appreciate help or directions to podcast if available.

3. Payer: Mix
   State: Ohio
   Code/Codes: 57 vs. 25 modifier
   Catagory: Other

   Question: When is best to use 25 vs. 57 same day procedure/OR - I thought anything requiring anesthesia would be OR procedure? Cysto/stent, cysto clot evaluation, etc would be 57 but is 25 more appropriate even if done in the OR?