Urology Coding Alert

Question: The urologist ablates tissue from the bladder neck level down toward the verumontanum. He removes the prostatic tissue to the surgical capsule at the 3 to 9 o'clock position. I see this wording on both HoLEP and HoLAP procedures. Should I add modifier 52 to 52649/52648 if the urologist enucleated/lasered only the median lobe?

Answer: You do not need to attach modifier 52 (Reduced services) to 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]) or 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]) in the clinical circumstances you describe.

Here's why: The extent of treatment of prostate gland obstruction is often difficult to determine when the urologist starts to use the terms partial or complete because these terms have different meanings to different urologists. Also, many times the only obstructive anatomy of the prostate is a large middle or median lobe with minimal overgrowth of the lateral and anterior lobes and the removal of the median lobe alone adequately removes the obstructive part of the prostate. Because of this when you have a clinical scenario such as the one you described, you should report 52648 or 52649 without modifiers.