Urology Coding Alert

Question: Our urologist performed a transrectal ultrasound on a patient prior to a transurethral needle ablation (TUNA) to determine the size of the prostate. He described this in his operative notes as a “prostate volume study.” How should I code it?

Missouri Subscriber

Answer: Performing a transrectal ultrasound (TRUS) before a TUNA is not considered a prostate volume study. A true prostate volume study involves 5 mm cuts and views, not just an ultrasound. To report a TRUS before TUNA, submit 76872 (Ultrasound, transrectal). Then report the TUNA with 53852 (Transurethral destruction of prostate tissue; by radiofrequency thermotherapy). If the scan is performed at the same encounter as the 53852, add modifier 59 (Distinct procedural service) or XU (Unusual non-overlapping service) to 76872 to undue the bundle between this pair of codes and be paid for both services.

Note: The urologist might perform other tests to determine prostate size in similar situations. Depending on the tactic, you could potentially report 53850 (Transurethral destruction of prostate tissue; by microwave thermotherapy) or 52647 (Laser coagulation of prostate, including control of postoperative bleeding, complete (vasectomy, meatotomy, cystourethroscopy, urethral calibration and/or dilation, and internal urethrotomy are included if performed)).