Urology Coding Alert

Come January, your prostate coding will undergo major changes.

"Code 52601 is a once in a lifetime code," has long been the mantra of urology coders. That ends Jan. 1 thanks to CPT Codes 2009, which makes drastic changes to the existing coding for reporting transurethral resection of the prostate (TURP) procedures.  The good news, however, is that those changes will make your job easier.

Turn To Modifiers 58 and 78 for Repeats

 As of Jan. 1, you'll find TURP codes 52612-52620 on the deleted list. You can cross the following codes off your TURP code set:
• 52612 -- Transurethral resection of prostate; first stage of two-stage resection (partial resection)
• 52614 -- ... second stage of two-stage resection (resection completed)
• 52620 -- Transurethral resection; of residual obstructive tissue after 90 days postoperative.

Old way: Prior to Jan. 1, 2009, you would report 52601 for the first TURP procedure a patient had in his lifetime. After that, if the patient needed follow-up TURP procedures, you had to turn to the other TURP codes no matter how long ago the original TURP had been, or even if another physician performed the original procedure.

If your urologist did a TURP for a patient who had a previous TURP, you would skip over 52601 and move right to 52620 or 52630 ( ... of regrowth of obstructive tissue longer than one year postoperative). You would have used the length of time between the patient's previous TURP and the current procedure to differentiate between those two codes.

Alternative: If the urologist performed a repeat TURP within the 90-day global period of an original TURP, you coded 52612 or 52614 for the second TURP. If you billed the initial TURP with 52601, you reported the second TURP with 52614 if this second resection completed the resection, and the urologist didn't anticipate or plan any further resections. If your urologist anticipated performing more than one TURP within the global period of the first billed TURP, you would have reported 52612.

New way:  CPT now advises the following: "For first stage transurethral partial resection of prostate, use 52601 (Transurethral electrosurgical resection of prostate, including control of postoperative bleeding, complete [vasectomy, meatotomy, cystourethroscopy, urethral calibration and/or dilation, and internal urethrotomy are included]). For second stage partial resection of prostate, use 52601 with modifier 58 (Staged or related procedure or service by the same physician during the postoperative period)."

 "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."

Update Your 52630 Knowledge

 CPT will change the wording on the descriptor for code 52630 to the following: "Transurethral resection; residual or re-growth of obstructive prostate tissue including control of postoperative bleeding, complete (vasectomy, meatotomy, cystourethroscopy, urethral calibration and/or dilation, and internal urethrotomy are included)." Note that this new definition for 52630 does not include a time frame with reference to a previous TURP.

What it means: CPT advises: "For transurethral resection of residual or regrowth of obstructive prostate tissue, use 52630" when your urologist performs the resection for residual tissue or regrowth any time after the original TURP.

Example: Your urologist is treating a patient who had prostatic surgery 10 years ago by another physician, but the patient has had significant regrowth of prostatic tissue and is quite symptomatic. Your physician decides the patient needs surgery and performs a second TURP. Even though the work involved may be equivalent to an initial TURP, you'll still report 52630, not 52601, because of the history of a prior TURP.

Most urology coders expect the changes to make coding TURP procedures easier. "It will be easier to choose a code since there are less of them in quantity terms," says Samantha Daily, medical biller for Urologic Consultants PC in Portland, Ore.
 
Cross 52606 Off Your List, Too

CPT 2009 also deleted code 52606 (Transurethral fulguration for postoperative bleeding occurring after the usual follow-up time), which fell within the same section of codes as TURP procedures. CPT 2009 instructs you to now use 52214 (Cystourethroscopy, with fulguration [including cryosurgery or laser surgery] of trigone, bladder neck, prostatic fossa, urethra, or periurethral glands) for transurethral fulguration of prostate.
 Note: The notes following 52214 in the CPT manual explain that if your urologist performs transurethral fulguration of prostate tissue during the post-op period of 52601 or 52630, during the post-op period of a related procedure, or for post-op bleeding, you should append modifier 78 (Unplanned return to the operating/procedure room by the same physician following initial procedure for a related procedure during the postoperative period) to 52214.