Urology Coding Alert

Question: We had a patient with BPH present for a TURP procedure. Before performing the TURP, the urologist performed an internal urethrotomy. I know the CPT descriptor for 52601 says that the internal urethrotomy is included in the TURP, but is this procedure ever separately billable? In this case, the urethrotomy was performed for a stricture in the anterior bulbous urethra.

UCA Subscriber

Answer: Don't assume code 52601's descriptor "internal urethrotomy included" prohibits you from separately reporting any urethrotomy prior to a transurethral electrosurgical resection of the prostate 52601's definition of an internal urethrotomy does not include those urethrotomies performed for pre-existing urethral strictures.

If a patient presents with an enlarged prostate secondary to benign prostate hyperplasia (BPH) and also a stricture in the anterior urethra, and the urologist performs and internal urethrotomy before the TURP to treat the stricture, the correct coding for this scenario 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]) and 52276-59 (Cystourethroscopy with direct vision internal urethrotomy; Distinct procedural service).

The "internal urethrotomy" described as "included" in code 52601's descriptor really accounts for those internal urethrotomies performed in the absence of a specific pathology (e.g., a stricture). In the past, urologists often performed internal urethrotomies using various types of urethrotomies prior to TURP to facilitate, by increasing the caliber of the urethral lumen, the passage of the larger instruments necessary to perform the TURP. But now instrumentation has improved, and the "standard" pre-TURPurethrotomies are rarely necessary with the exception of instances when patients scheduled to have TURPs are found to have congenitally smaller urethral diameters.

Code CPT 52276 often gets grouped into the bladder neck contracture treatment codes, but it applies to a very unique type of treatment: the incision of a stricture in the urethra at the vesico urethral junction after a radical prostatectomy. Because this anastomotic stricture is found between the urethra and bladder, where the bladder neck would be located prior to its removal during a radical prostatectomy, coders often mistakenly label this stricture a bladder neck contracture when there is no longer a bladder neck to contract. In other words, the bladder neck has been removed with a radical prostatectomy, so if you are coding an incision of the bladder neck for treatment of a stricture for a patient who has had a radical prostatectomy, you'd better think again chances are 52276 is the code that actually applies.