Urology Coding Alert

Hint: Pay special attention to the patient’s history.

Just because transurethral resection of the prostate (TURP) procedures may be common for urologists doesn’t mean coders don’t sometimes have questions. Brush up on the basics with advice from two urology coding experts, including how to handle postoperative complications.

Verify Whether the Patient Had a Previous TURP

If your urologist sees a patient with lower urinary tract obstructive symptoms or urinary retention who has failed conservative medical therapy, he would be a candidate for a surgical treatment such as a TURP.

When you see a chart involving TURP, your first step in correctly coding the procedure is double checking whether the patient has had a previous TURP procedure.

If the answer is “no,” CPT^® has only one code to represent the situation, says Becky Boone, CPC, CUC, CPMA, urology surgery coder for The Coding Network and coder for the University of Missouri Internal Medicine Department in Columbia. That choice is 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]).

Good to know: Often, a urologist will perform additional procedures, such as prophylactic vasectomy or cystourethroscopy before the TURP procedure. However, as 52601’s code descriptor indicates, these procedures are included in the TURP, and you cannot separately report them and payers will not separately pay you for them.

Shift to 52630 for a Repeat TURP

Michael A. Ferragamo MD, FACS, assistant clinical professor of urology with the State University of New York, University Hospital and Medical School at Stony Brook, points out that if your urologist’s documentation of past surgical procedures indicates that the patient had a previous TURP, and he now presents with recurrent obstructive symptoms due to residual or regrowth of prostatic tissue, you should not report 52601 for the second TURP procedure. Instead, you should submit 52630 (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]).

Caution: Sometimes the urologist will use another procedure to treat residual growth after an initial TURP, such as laser prostatectomy (52648, Laser vaporization of the 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 or 52649, Laser enucleation of the prostate with morcellation ...). If so, you will report the appropriate code for one of the laser procedures above, not the “second repeat TURP” code 52630.

Thoroughly review your urologist’s documentation, including the patient’s past surgical history to be sure you don’t report an incorrect code. Even if another urologist performed the original TURP years ago, you should still report 52630 for the repeat procedure your surgeon performs.

“Good documentation is the key for successfully coding a TURP procedure,” Boone says. “The challenge is making sure that they document if there was a previous TURP or whether another endoscopic prostatectomy was performed, and that they are clear on the type of prostatectomy that was performed (e.g., a TURP or a green light laser vaporization of the prostate).”

Code it: Report a repeat green light laser with code 52648 or 52649, as there is no special CPT^® code for a repeat green light laser vaporization of the prostate, unlike there is for a repeat TURP.

Prepare for Potential Post-op Complications

As with any surgery, patients can potentially encounter complications. For cases involving TURP, let the global period guide your code choice.

Example: A patient had a TURP that you coded as 52601. He returns to your office 14 days later with recurrent urinary retention. You should consider the urinary retention as a complication of the TURP. Your original procedure code 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]) carries a 90-day global period. Because the retention occurred 14 days after the surgery, you are dealing with a complication within the global period.

The problem: Medicare will only pay for the treatment of a complication when your urologist returns the patient to the operating room (OR). In that case, add modifier 78 (Unplanned return to the operating/procedure room by the same physician or other qualified health care professional following initial procedure for a related procedure during the postoperative period) to the surgical code. For the example scenario, if it is necessary to return the patient to the operating room to insert a Foley catheter, report 51702 (Insertion of temporary indwelling bladder catheter; simple [e.g., Foley]) with modifier 78. If the urologist is able to place the Foley catheter in his office while in the global period of the TURP (52601), you should not bill for the insertion. Also note that you will not be paid for code 51702.

Private payer difference: Remember that many non-Medicare payers will reimburse for the treatment of a complication whether the treatment takes place in the office or the OR.

In you are billing a private payer in this scenario, report 51702 with modifier 79 (Unrelated procedure or service by the same physician or other qualified health care professional during the postoperative period), if the catheter is placed in the office. Shift to 51702-78 if the urologist places the catheter in the operating room.

You should be able to bill 51798 (Measurement of post-voiding residual urine and/or bladder capacity by ultrasound, non-imaging) for both Medicare and non-Medicare payers in any location (office or hospital) as this is a radiology code and is not included within a global period.