Urology Coding Alert

Question: The urologist performed a TRUS and prostatic biopsy because of an elevated PSA, and a TURP for LUTS secondary to prostatic enlargement, bladder neck obstruction, and chronic urinary retention. Can we bill for a TURP and a TRUS with biopsy in the same setting?

Texas Subscriber

Answer: Yes, you can bill for both procedures. For this surgical encounter, you should report the following codes if your urologist performed all of these procedures in the hospital:

• 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]). Attach diagnosis code 600.01 (Hypertrophy [benign] of prostate with urinary obstruction and other lower urinary tract symptoms, [LUTS]).
• 55700 (Biopsy, prostate; needle or punch, single or multiple, any approach). Append modifier 59 (Distinct procedural service) to break the bundle between 52601 and 55700. Attach diagnosis code 790.93 (Elevated prostate specific antigen, [PSA]). Append modifier 51 (Multiple procedures) for non- Medicare claims if needed.
• 76872 (Ultrasound, transrectal). Append modifier 26 (Professional component) to show that your urologist performed the interpretation and report. Attach diagnosis code 790.93.
• 76942-26 (Ultrasonic guidance for needle placement [eg, biopsy, aspiration, injection, localization device], imaging supervision and interpretation). Attach diagnosis code 790.93.