Urology Coding Alert

Question: I am unsure of how to code a transurethral prostate vaporization procedure that is not complete. The urologist states that he only did the middle lobe because that was the area that caused the urinary obstruction. I do not see documentation for surgery in the past for this prostatic enlargement, and the urologist did not state the possibility that the patient needed to come back for further vaporization treatment. What should I report? Massachusetts Subscriber

Answer: You should report 52648 (Laser vaporization of prostate, including control of postoperative bleeding, complete[vasectomy, meatotomy, cystourethroscopy, urethral calibration and/or dilation, internal urethrotomy and transurethral resection of prostate are included if performed]) without any modifier.

Middle lobe obstruction of the prostate is an anatomical formation of an enlarged prostate with often little growth of the lateral lobes and anterior commissure. These anatomically enlarged prostates often require only removal of the middle or median lobe with little else more. Code 52648 is appropriate in this case because your urologist stated that the middle lobe was obstructive and therefore was vaporized. You shouldn't use a modifier because the urologist did not suggest that this would be a staged procedure or that he intended to return the patient to the operating room (OR) for further vaporization because of initial incomplete vaporization of the prostate.

Alternative: If the urologist did return the patient to the OR for further vaporization because of an initial incomplete vaporization of the prostate you would instead report 52648 for the first vaporization and 52648-78 (Unplanned return to the operating/procedure room by the same physician following initial procedure for a related procedure during the postoperative period) for the second vaporization during the global of the initial procedure. This is similar to what is expressed in the 2009 CPT manual for a repeat transurethral resection of the prostate (TURP).