Urology Coding Alert

Question: What is the correct code for a biopsy of the prostatic urethra?

Oklahoma Subscriber

Answer: The answer depends on the biopsy method.

For a cystoscopic, cold cup biopsy, code 52204
(cystourethroscopy, with biopsy). For a transurethral loop biopsy, code 52601 (transurethral resection of prostate, complete) with modifier -52 (reduced services). Modifier -52 tells the payer that you didnt perform the full transurethral prostatectomy (TURP). Be sure to file this by paper claim, with the operative report attached. Also provide a simple, short explanation of the procedure in laymans terms. Note the percentage of the TURP performed.

A transurethral loop biopsy equals about 20 percent of the full TURP. If you perform less than 50 percent of the full TURP, most payers will pay you one-third to one-half of the fee.

Note: If you send the claim electronically, some carriers will ignore the modifier -52 and pay full fee. You would then be expected to refund the overpayment and explain your use of modifier -52 and spend extra time on paperwork that you would rather not have to do.

As an alternative to using modifier -52, you can code a partial prostatectomy (52612, transurethral resection of prostate; first stage of two-stage resection [partial resection]) without a modifier. Again, send a paper claim and include the operative report.