Urology Coding Alert

Question: I am a little confused on how to bill for evacuation of clots and fulguration of bleeders after TURP (on a different day). Should I use 52001-78 or 52606-78? I think the language in 52606 is what's confusing me: "... after the usual follow-up time." Can you clarify this? New York Subscriber Answer: The secret to choosing between 52214 and 52606 is in when the fulguration was performed: during or after the postoperative period. If the fulguration of the prostatic fossa was performed during the global period of the TURP, which has a 90-day global period, you need to code 52214-78 (Cystoureth-roscopy, with fulguration [including cryosurgery or laser surgery] of trigone, bladder neck, prostatic fossa, urethra, or periurethral glands; Return to the operating room for a related procedure during the postoperative period).

Remember that the above rule relates to Medicare. However, if the carrier strictly follows the CPT definition of 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]), you will often not be reimbursed for your additional procedure to control postoperative bleeding. In any event, if the fulguration was performed after the global period, you need to use 52606 (Transurethral fulguration for postoperative bleeding occurring after the usual follow-up time). As for the irrigation of the clots, 52001-78-59 (Cystourethroscopy with irrigation and evacuation of multiple obstructing clots; Distinct procedural service) may be used if the irrigation of clots represented a significant procedure, i.e., took an extra long time for the irrigations, and the clots were multiple and obstructing the bladder outlet and could not be removed by normal catheter irrigations. Modifier -59 is used to unbundle 52001 from 52214. Another coding scenario for less extensive clot removal and prostatic fossa fulguration would include:

52214-78
51700*-78-51 (Bladder irrigation, simple, lavage and/or instillation) with modifier -51 (Multiple procedures)

CPT code 51700 is not bundled into code 52214.