Urology Coding Alert

Question: One of my doctors completed a TURP for a patient with metastatic cancer who’d had a previous TURP two years ago. The doctor seems to think that there might an exception to the rule in terms of coding, since the second TURP was done because of the regrowth of prostate cancer with extension of the tumor up into the trigone.

Mississippi Subscriber

Answer: You normally can bill 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]) only once for a patient.

The above scenario this represents a repeat TURP and should only be billed with 52630 (Transurethral resection; residual or regrowth of obstructive prostate tissue, including control of postoperative bleeding, complete [vasectomy, meatotomy, cystourethroscopy, urethral calibration and/or dilation, and internal urethrotomy are included]). If your urologist felt that extra work in this case was due to the extension of the prostatic tumor into the trigone, and the resection of the trigonal component increased the complexity and over all time of the repeat TURP procedure, then add modifier 22 (Increased procedural services) to 52630. Also include thorough documentation in the operative report and a covering letter explaining what was performed and why. That can help you obtain increased reimbursement from the insurer.