Urology Coding Alert

Question: A patient had two Greenlight vaporizations of the prostate (52648) about 15 months apart. The urologist’s dictation does not indicate it was a staged procedure. I cannot find any documentation that clearly indicates that 52648 is a once-in-a-lifetime procedure, although I’ve seen some insurer policies making it once-in-a-lifetime. Is 52649 a subsequent Greenlight in the same way the 52630 is a subsequent 52601? Or is there another code I should use for the second procedure?

Florida Subscriber

Answer: To answer your underlying question, 52648 (Laser vaporization of 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)) is not a once-in-a-lifetime code unless the payer indicates that in its policies. For payers that do not designate it as such, you should be able to report 52648 for both procedures with explanatory documentation and be paid for both procedures.

Also note that 52649 (Laser enucleation of the prostate with morcellation, 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)) does not represent a simple laser vaporization; it is for laser enucleation, which is a different, more complicated laser technique. If a laser procedure is performed, report 52648 whether it’s the initial procedure or a repeat. Code 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)) is used to report a repeat transurethral resection for regrowth of the prostate (TURP).

To answer your comparison question, after first performing a 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)), the physician may repeat the TURP at another session and bill 52630, or 52648 if this is the repeat procedure and is performed by laser.

After an initial procedure reported with 52648, the urologist may repeat the Greenlight laser at a second sitting and again bill 52648. If a payer considers CPT^® code 52648 a once-in-a-lifetime procedure, you can bill a second/repeat laser with 52649, especially if a laser enucleation is now performed. However, this stance by payers is not very common.