Urology Coding Alert

Question: Is it appropriate to unbundle CPT^® codes 52001 and 52630 in order to bill both?

Wisconsin Subscriber

Answer: Coding edits classify 52001 (Cystourethroscopy with irrigation and evacuation of multiple obstructing clots) as a Column 2 code for 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)). However, in some circumstances you might be allowed to append a modifier to 52001 and report both codes.

Remember: Just because a modifier may be allowed does not mean you can automatically append one (such as modifier 59, Distinct procedural service) and assume the claim will be paid. You will need clear documentation in the surgeon’s operative notes of an unusual circumstance beyond normal treatment as a reason to unbundle the edit and report both codes.

If the irrigation is performed during the TURP, it is considered part of the procedure and not separately reportable. If the irrigation is performed for something outside of the TURP, it might be payable – but it would still need to be for a reason unrelated to the TURP.

Example: A urologist initially reports 52001 for cystoscopic irrigation and evacuation of multiple obstructive clots. This represents a different separate procedure before he performs a repeat TURP (52630). This bundled edit can be broken and both CPT^® codes paid by submitting 52630 and 52001 with modifier 59 or XS (Separate structure).