Urology Coding Alert

Question: My doctor performed a cystourethroscopy with evacuation of clots from the bladder and transurethral vaporization of the prostate to control prostatic varices. He used a rectoscope with a vaporizing electrode for the procedure. I know the evacuation of clots is 52001, but I'm stuck on the vaporization. I would code 52648 for vaporization by contact laser, but I don't think that's correct.

Louisiana Subscriber

Answer: You should report CPT 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]) for the procedure you describe. 

This question came up years ago when the transurethral vaporization instruments became available. At that time, the AUA suggested that the TURP CPT code was the proper code, since this technology was an "electrosurgical resection" of the prostate. Therefore, CPT code 52648 (Contact laser vaporization with or without transurethral resection of prostate, including control of postoperative bleeding, complete [vasectomy, meatotomy, cystourethroscopy, urethral calibration and/or dilation, and internal urethrotomy are included]) is not appropriate with the instrumentation that your urologist used.

Remember: Use code 52001 (Cystourethroscopy with irrigation and evacuation of multiple obstructing clots) only if the cystoscopy and clot removal were for multiple and obstructing clots -- in other words, the patient really was in clot retention, and the evacuation of clots required a lot of time and effort. In this case, append modifier -59 (Distinct procedural service) to 52001 to unbundle it from 52601.