Urology Coding Alert

Question: How should I bill a transurethral prostate biopsy? Should I use code 55700?

New York Subscriber

Answer: You are having difficulty finding a suitable code for the transurethral resection of the prostate (TURP) biopsy because technically there isn't one. CPT code 55700 is not appropriate because the code definition strictly states that it is for a needle biopsy of the prostate gland and not for a TURP biopsy. For a true TURP biopsy, you need to use an unlisted-procedure code such as 53899 (Unlisted procedure, urinary system).

If, on the other hand, the prostate biopsy is only of the urethral mucosa or lining, you should use code 52204 (Cystourethroscopy, with biopsy).

Alternatively, if you do a deeper biopsy, such as with the resectoscope loop to access deeper tissues, i.e., the acini and deeper tubules, then use one of the prostate resection codes with modifier -52 (Reduced services) to indicate that you did not do a full resection. For example, you can use 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]) with modifier -52. When opting to use this code, you will need thorough documentation indicating the amount of the TURP, e.g., "15 to 20 percent of a full resection to obtain biopsies."

Another option is to use the partial resection code 52612 (Transurethral resection of prostate; first stage of two-stage resection [partial resection]), also with thorough documentation.