Medicare Compliance & Reimbursement

CPT changes now allow you to use one code with a modifier for stages 1 and 2 of TURP.

You need to forget everything you know about coding TURP procedures.

That's because CPT 2009 makes drastic changes to the existing advice for reporting transurethral resections of the prostate (TURP).

As of Jan. 1, you'll find TURP codes 52612-52620 on the deleted list. CPT now advises the following: "For first stage transuretharal partial resection of prostate, use 52601 (Transurethral electrosurgical resection of prostate...). For second stage partial resection of prostate, use 52601 with modifier 58 (Staged or related procedure or service by the same physician during the postop period). For trans-    urethral resection or regrowth of obstructive prostate tissue, use 52630."

CPT will change the wording on code 52630 to the following: "Transurethral resection; residual or regrowth of obstructive prostate tissue including control of postoperative bleeding, complete (vasectomy, meatotomy, cystourethroscopy, urethral calibration and/or dilation, and internal urethrotomy are included)."

"The big adjustment here will be that coders are used to billing 52601 only once in a patient's lifetime," says Ann Howard of Howard Urology in Boston. "Now it appears that you'll be able to bill it again, but with modifier 58 on it."

Plus: CPT 2009 makes HPV code 90650 (Human Papilloma virus [HPV] vaccine, types 16, 18, bivalent, 3 dose schedule, for intramuscular use) official. "This code was in effect for 2008 but didn't make it into CPT 2008, so some practices had to battle their payers to get it recognized," says Orinda Marcus of Big Sky Billing in Helena, MT.

Also new to CPT 2009 for January use are the following two additional vaccine codes:
 • 90681 -- Rotavirus vaccine, human, attenuated, 2 dose schedule, live, for oral use
 • 90696 -- Diphtheria, tetanus toxoids, acellular pertussis vaccine and poliovirus vaccine, inactivated (DTaP-IPV), when administered to children 4 years through 6 years of age, for intramuscular use.