Urology Coding Alert

Transurethral resection of the prostate (TURP) procedures are commonplace in urology practices, but coding these surgeries is often anything but common. With five codes to choose from, you need to know the intricacies of TURP coding rules to ensure you pick the proper code in every situation. Let our experts give you the coding tools you need to hone your TURP knowledge.

The first code most coders turn to when reporting TURP procedures is 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]).

Important: "Code 52601 represents a 'once-in-a-lifetime' procedure which you can report only once per patient," says Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology at the State University of New York, Stony Brook. "If the patient has already had a TURP procedure, you cannot use 52601 a second time, and you need to look at the other TURP codes."

"The prostate gland can only be resected or removed once," explains Vickie Rhodes, CPC, billing and coding specialist for Greenwood Urological in South Carolina. "If the patient develops obstructive symptoms postoperatively it is considered residual tissue from the prostate, but there isn't an actual gland left to resect."

Example: Your urologist sees a patient with frequent urination and hematuria, and the physician diagnoses benign prostatic hyperplasia (BPH), also known as an enlarged prostate gland. Because the patient's symptoms are severe, your urologist decides to perform a TURP. You should report 52601 along with diagnosis code 600.01 (BPH with urinary obstruction ...).

Don't overcode: The TURP procedure, and the definition of 52601, includes several other urological services, including meatotomy and urethral dilation. Because these procedures are intrinsically part of the TURP procedure, you can't report them separately and, therefore, you should report only 52601.

Remember: "Do not choose a TURP code based on the technique the urologist uses for the procedure or on the amount of prostatic tissue he removes," Ferragamo says. "If the physician does a channel TURP, for example, consider that simply a specific technique of the procedure, and report 52601."

If your urologist does a TURP for a patient who has had a previous TURP, skip over 52601 and move right to 52620 (Transurethral resection; of residual obstructive tissue after 90 days postoperative) or 52630 (... of re-growth of obstructive tissue longer than one year postoperative). Use the length of time between the patient's previous TURP and the current procedure to differentiate between those two codes.

The key: For a repeat TURP after the 90-day global period of the original or initial procedure, but less than one year later, use 52620. You should report 52630 when your urologist performs a TURP for a patient who had a previous TURP more than one year ago.

Note: Use 52620 or 52630 whether your urologist or another physician performed the surgery.

Example: Your urologist is treating a patient who had prostate surgery 10 years ago by another physician, but the patient has significant prostate tissue remaining. Your physician decides the patient needs surgery and performs a second TURP. Even though the work involved may be equivalent to an initial TURP, report 52630, not 52601, because there is evidence and a history of a prior TURP.

Tip: "Although CPT code 52620 states that it represents a resection of 'residual obstructive tissue,' and CPT code 52630 describes a resection of 're-growth of obstructive tissue,' these specific CPT definitions should not change how you should code a repeat TURP," Ferragamo says.

The way you'll report a repeat TURP your urologist performs within the 90-day global of an initial TURP will depend on whether you have already billed the initial TURP. If you have coded and billed the initial TURP with 52601, you should report the second TURP with 52614 (Transurethral resection of prostate; second stage of two-stage resection [resection completed]) if this second resection completes the resection and the urologist doesn't anticipate or plan any further resections. Be sure to add modifier 58 (Staged or related procedure or service by the same physician during the postoperative period) to 52614 to indicate that the second surgery represents a "staged" procedure, Ferragamo says. Expect full payment for 52614.

Under rare clinical circumstances, such as an enlarged cancerous prostate gland, the urologist may anticipate performing more than one TURP within the global period of the first billed TURP, Ferragamo says. In this case, use 52612 (... first stage of two-stage resection [partial resection]). Again, you should append modifier 58 to indicate a staged procedure.

Alternative: If you have not already billed the initial TURP with 52601 or if the urologist actually plans to remove the prostate in two stages (because of its large size or other technical or clinical reasons), code the two procedures using 52612 for the first TURP and 52614-58 for the second TURP. Add modifier 58 to the second TURP since urologists usually perform the two procedures within weeks of each other, and 52612 has a 90-day global period.

Example: A patient undergoes a TURP for an obstructive prostate gland, but is unable to void after the procedure. On postoperative day 15, the urologist performs a second TURP and completes the resection removing additional prostatic tissue. The patient now voids without difficulty. Code this clinical scenario as follows: 52601 and 52614-58 or 52612 and 52614-58 depending on how you reported the initial TURP.

Example 2: A patient does extensive reading on the Internet and informs your urologist he does not want to have a full TURP because he is concerned about post-operative impotence, so the physician performs a partial resection of the prostate gland. In this case, you should report 52612 if the urologist documents that he plans to possibly complete the resection, if necessary, at a later date, Rhodes says.