Urology Coding Alert

Question: The urologist did a TURP one day and then had to go back unexpectedly two weeks later and do another TURP to remove residual obstructing tissue because the patient could not void. Should I consider this a second-stage TURP even though the physician did not mention the second procedure in his original operative note? The second procedure was still within the 90-day global period of the first

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Answer: The coding for the second procedure will depend on whether you have already coded and billed for the initial transurethral resection of the prostate (TURP).

If you have already reported and billed for the initial TURP using 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 should report the second TURP with 52614 (Transurethral resection of prostate; second stage of two-stage resection [resection completed]) because 52601 is a "once in a lifetime" procedure per patient, so you can only bill this procedure once for a patient.

Don't forget: Append modifier 58 (Staged or related procedure or service by the same physician during the postoperative period) to 52614 indicating that although the urologist did not anticipate a staged procedure, the patient needed a second TURP. The diagnosis would be the same for both procedures: 600.01 (BPH with urinary obstruction).

If you have not already coded for the initial TURP, use 52612 (Transurethral resection of prostate; first stage of two-stage resection [partial resection]) for the first procedure and 52614-58 for the second TURP.

-- Answers to Reader Questions and You Be the Coder contributed by Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology, State University of New York, Stony Brook.