Urology Coding Alert

Question: The urologist performed a TRUS and prostatic needle 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 a needle 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 N40.1 (Benign prostatic hyperplasia with lower urinary tract symptoms).
• 55700 (Biopsy, prostate; needle or punch, single or multiple, any approach). Append modifier 59 (Distinct procedural service) or XU (Unusual non overlapping service, using different technology) to break the bundle between 52601 and 55700. Attach diagnosis code R97.20 (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 only performed the interpretation and report. Attach diagnosis code R97.20.