# Holmium laser ablation prostate



## ccipollacpc

Please explain the difference among CPT codes 52647 (laser to coagulate, 52648 (laser to vaporize), 52649 (laser to enucleate). The physician documentation indicates "the holmium laser was used to ablate the prostate" and "a resectoscope was used to resect the necrotic tissue as well as some of the prostate". Then, "all of the fragements were drained out and sent to pathology". We were thinking that the best code to use in this scenario was 52648 but we weren't sure if 52649 might be better. Can you please clarify?


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## magnolia1

I would go with 52648.


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## ccipollacpc

*holmium laser ablation prostate*

Thank you. That is the code we used. What do you use as the basis for your rationale and decision on which code to use?


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## magnolia1

The basis for my rationale is the documentation provided to me.

As in your case, the term "coagulation" was not used, nor do I see a "morcellation" (52649) described.

Please refer to the CPT Assistant below that explains 52647 & 52648:

Surgery: Urinary System 

Question:

What is the difference between codes 52647, Laser coagulation of prostate, including control of postoperative bleeding, complete (vasectomy, meatotomy, cystourethroscopy, urethral calibration and/or dilation, and internal urethrotomy are included if performed), and 52648, Laser vaporization of prostate, including control of postoperative bleeding, complete (vasectomy, meatotomy, cystourethroscopy, urethral calibration and/or dilation, internal urethrotomy and transurethral resection of prostate are included if performed)?

AMA Comment:

From a CPT coding perspective, code 52647 describes noncontact laser coagulation of the prostate. This code is intended to describe laser procedures that primarily heat the prostate and require sloughing for the treatment to be complete. This code should be used even if an incision or small amount of vaporization is done in combination with the coagulation. In this case, it is not appropriate to separately report code 52648 for the small amount of vaporization performed. Code 52648 describes contact laser vaporization with or without transurethral resection of the prostate. This code is used to report laser procedures that use a contact tip or high-power density. Contact vaporization is usually accomplished by moving a laser tip across the surface of the prostate, causing immediate vaporization of tissue and an end result that looks like a cavity (similar to the effect of a Transurethral Resection of the Prostate).




CPT Assistant © Copyright 1990–2008 American Medical Association. All Rights Reserved


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## ccipollacpc

*holmium laser ablation prostate*

Thank you again. That was the same rationale we used when coding from the documentation provided. Your help is appreciated.


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## sthomas@tnurology.com

This is one that even my coding instructor was unable to answer.  One doctor in my office calls it "revolix laser vapor resection of prostate" in the operative report, starts off stating he vapor resects a lobe using "semicircular swipes along the adenoma."  He then may say he makes a trough & removes the other lobes, but no other detail about the method, then he cauterizes the areas with the laser & removes the "chips" with the Ellik evacuator & forceps from the bladder.  He believes the term "chips" should tell me this is enucleation, 52649, but I feel this falls more toward 52648 due to lack of detail.  Another doctor in my office that does do the enucleation states in the operative report "the enucleation was performed in the standard fashion," then begins "enucleation by troughing the 5 o'clock and the 7 o'clock position enucleating the prostatic chips back into the prostate," and his dictation continues to be that clear about the procedure as it is being done in each section of the prostate & fully supports 52649 as far as I can tell.  What is the best way to determine the correct code if there is question &/or describe what is needed in the dictated operative report to support 52649 instead of 52648?


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