Urology Coding Alert

Question: My urologist performed a TURP followed with a suprapubic cystotomy with suture of the inferior vesical artery at the level of the bladder neck. Is the suture of the vesical artery included in 52601 for the TURP??

Texas Subscriber

Answer: No. The suture of the vesical artery would not be included in 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]).

The suture procedure via a suprapubic cystotomy is to control excessive bleeding following the TURP. So report  the transurethral resection of the prostate (TURP) using 52601, and then bill the 51040 (Cystostomy, cystotomy with drainage) for the suprapubic cystotomy with suture performed on the same day and during the same encounter as the TURP. Append modifier 59 (Distinct procedural service) to the cystostomy code (51040) to indicate your urologist performed a separate procedure during the same encounter as the TURP.

Exception: If the patient is "returned to the operating room" following an initial TURP later that day or in the postoperative period of the TURP, append modifier 78 (Unplanned return to the operating/procedure room by the same physician following an initial procedure for a related procedure during the postoperative period) to 51040 since your urologist is treating a complication resulting from and taking place within the 90-day global of the transurethral resection of the prostate gland.

Potential bonus: You may be able to add modifier 22 (Increased procedural services) to 51040 to capture extra payment for the extra work of suturing at the bladder neck. But, keep in mind that you most likely will receive only an extra $50-$100 more, if anything at all, and attaching modifier 22 will hold up your claim. You need to decide whether that small extra amount -- if the insurance

carrier will even pay -- is worth holding up your reimbursement.