Urology Coding Alert

The ‘once-in-a-lifetime’ rule on TURPs limits the codes you can report

Determining which code to report for transurethral resection of the prostate (TURP) procedures can be a daunting task. Read on to find the answers to some frequently asked questions about reporting TURP procedures.

You have only five CPT Codes to choose from to report TURP procedures, but selecting the right one can be tricky. The most commonly used TURP codes are 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]), CPT Code 52620 (Transurethral resection; of residual obstructive tissue after 90 days postoperative), and 52630 (... of regrowth of obstructive tissue longer than one year postoperative).

You Can Report 52601 Only Once

The first code you should consider for reporting a TURP procedure is 52601. During a TURP, the urologist inserts a resectoscope through the urethra and removes a portion of the prostate. The TURP procedure, and the definition of 52601, includes several other urological services, including meatotomy and urethral dilation. Because these procedures are intrinsically part of the TURP procedure, you can’t report them separately and, therefore, you should only report 52601.

Note: Code 52601 represents a “once-in-a-lifetime” procedure and you can report it only for the first TURP done on a patient, says Morgan Hause, CCS, CCS-P, privacy and compliance officer for Urology of Indiana LLC, a 31-urologist practice in Indianapolis.

Coding example: A patient with frequent urination, overflow incontinence and hematuria presents to your practice. Your urologist concludes that the patient has benign prostatic hyperplasia (BPH), commonly referred to as enlarged prostate. Because the patient’s symptoms are severe, your urologist decides to perform a TURP. You should report 52601 along with diagnosis code 600.01 (BPH with urinary obstruction).

Use 52620 for Repeat TURPs Within 1 Year

When your urologist performs a TURP on a patient who has had a previous TURP, you’ll need to report either 52620 or 52630 in place of 52601. “Code 52620 is for patients who have had a previous TURP, over 90 days ago but less than one year ago, by any provider,” Hause says.

Coding example: Your urologist sees a patient who has a prostatic fossa with regrown prostatic tissue from prostate cancer. The doctor performs a cystoscopy and evacuation of multiple obstructing clots, followed by a TURP. The patient had a prior TURP procedure just eight months before. You should report 52001-59 (Cystourethroscopy with irrigation and evacuation of multiple obstructing clots) for the cystoscopy and for the evacuation of clots. For the TURP procedure, which falls within one year of the patient’s first TURP, use 52620.
 
Remember: Use 52001 only if the cystoscopy and clot removal were for multiple and obstructing clots, meaning that the patient was in clot retention and the evacuation of clots required sufficient time and effort to accomplish. When you report both 52001 and 52620, append modifier 59 (Distinct procedural service) to 52001 to unbundle it from 52620. Be sure to list 52620 first because it is the primary procedure, and then list 52001-59.

52630 Covers Repeat TURPs After 1 Year

You should report 52630 when your urologist performs a TURP for a patient who had a previous TURP more than one year ago. Because CMS allows you to report 52601 only once in a patient’s lifetime, you should not use 52601 even if the patient had the prior TURP several years ago or by another physician. You can’t report 52601 for any TURP procedure conducted more than one year after the first; you need to use 52630.

Coding example: Your urologist is treating a patient who had prostate surgery 10 years ago by another physician, but the patient has significant prostate tissue remaining. Your physician decides the patient needs surgery and performs a complete TURP. Even though the work involved is equivalent to doing an original TURP, you should still report 52630, not 52601, because there is evidence and history of a prior TURP.
 
Good idea: Don’t let the code descriptors fool you. The terms “regrowth” and “residual” in 52620 and 52630’s definitions can be confusing when you’re deciding whether those codes apply to procedures that your urologist performs. 

Code 52620 states that it represents a resection of “residual obstructive tissue,” and 52630 describes a resection of “regrowth of obstructive tissue.” But these definitions should not change how you code a repeat TURP, says Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology at the State University of New York, Stony Brook. “One cannot really know what is regrowth or residual, or tissue left unresected, and these terms are often clinically interchangeable,” he adds.

Partial vs. Complete Determines 52612 or 52614
 
You’ll rarely use codes 52612 (Transurethral resection of prostate; first stage of two-stage resection [partial resection]) and 52614 (... second stage of two-stage resection [resection completed]) because a urologist typically completes a TURP in one session, Hause says.

If a patient has surgery within the 90-day global period of the original TURP, you should use 52614. Be sure to add modifier 58 (Staged or related procedure or service by the same physician during the postoperative period) to 52614 to indicate that the second surgery is related to the original TURP.
 
Note: If your urologist feels that even another, or possibly a third or fourth, TURP may be required within the global period of the second surgery, you should report 52612 rather than 52614, since the code descriptor for 52614 indicates a “completed resection.” In this case, the physician should indicate in his operative report that the patient may need follow-up TURPs. This documentation would support the claim that the present procedure may be part of a subsequent staged procedure.