Urology Coding Alert

Question: The doctor did a TURP procedure for BPH and LUTS but also did a suprapubic tube insertion using a Lowsley retractor placed into the urethra and extended up to the abdominal wall. Would this be included in the TURP procedure code (52601) or can I bill separately for the insertion? If I can bill separately, is 51102 the correct choice or is there another code that I can bill?

Connecticut Subscriber

Answer: Using the Lowsley retractor to perform a suprapubic cystostomy includes incisions of the skin, subcutaneous tissues, abdominal fascia, muscle, peri-vesical fat, and an incision of the bladder wall with subsequent placement of a suprapubic tube into the bladder lumen.

Since all tissue layers are incised, this constitutes a true open cystostomy and drainage procedure, which leads you to code 51040 (Cystostomy, cystotomy with drainage). However, the Correct Coding Initiative bundles this code into the transurethral resection of the prostate (TURP) 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]) but has a modifier indicator of “1,” meaning that you can override the edit with a modifier, such as XS (Separate structure) or 59 (Distinct procedural service), under certain clinical circumstances.

Example: If the cystostomy is unrelated to the TURP, and the diagnosis is separate and different from benign prostatic hyperplasia (BPH, N40.1), such as a case of anticipated long term drainage after the TURP for an accompanying atonic bladder (N31.2), you may code 52601 and 51040-XS or 52601 and 51040-59. 

Looking at a different clinical scenario, do not bill or unbundle 51040 if the suprapubic drainage is used in place of urethral catheter drainage and consequently would be considered part of the TURP. In this clinical scenario code only for the TURP using 52601.

Note: In this case you should not use 51102 (Aspiration of bladder; with insertion of suprapubic catheter), as that is a punch cystostomy with only a small skin incision made.