Urology Coding Alert

Want to know what you can bill with your claims for transurethral resection of prostate? Look no further We asked urology Coders what they'd like to see covered in a comprehensive format, and the answer was overwhelming: transurethral resections of the prostate (TURPs) ...quot; procedures that give you a run for your money when it comes to coding.
 
We've compiled four of our subscribers' most pressing TURP coding questions and asked our experts how to code them. Read on to firm up your TURP coding knowledge. Look to 52214 for Post-TURP Fulguration Question: Our urologist performed a TURP procedure, and two days later he had to take the patient back to the operating room to perform a fulguration of bleeding vessels within the prostatic fossa. I am planning to report 52606. Is this accurate?
 
Answer: "Most urologists usually use the transurethral approach when they fulgurate the prostatic fossa for bleeding after a TURP," says Laura Cwiklinski, office manager at urology Partners Inc. "It's a complication of the original procedure, and therefore, report  52214 (Cystourethroscopy, with fulguration [including cryosurgery or laser surgery] of trigone, bladder neck, prostatic fossa, urethra, or periurethral glands)."
 
Don't forget: Because the patient was still in his post-TURP global period, you should append modifier 78 (Return to the operating room for a related procedure during the postoperative period) to 52214, says Debbie Price, RHIT, coder at Cullman Urology PC.
 
For a TURP bleed, a surgeon may consider billing 52606 (Transurethral fulguration for postoperative bleeding occurring after the usual follow-up time), Cwiklinski says. However, the descriptor for 52606 states, occurring after the usual follow-up time. "I wouldn't consider two days to be usual follow-up time," Cwiklinski says.
 
The facts: "You would report 52606 for fulguration of bleeding only after the 90-day global period has ended," says Michael A. Ferragamo, MD, clinical assistant professor of urology, State University of New York Stony Brook.
 
In complicated cases when the urologist performs cystoscopy and finds multiple obstructing clots and initially irrigates them from the bladder and then fulgurates the bleeding, report the following combination, Ferragamo says:
 
• 52001-59 (Cystourethroscopy with irrigation and evacuation of multiple obstructing clots; Distinct procedural service) for the cystoscopy and irrigation of the multiple and obstructing clots.
 
• 52214 for the fulguration of the prostatic fossa.
 
Modifier 59 breaks the bundle that the National Correct Coding Initiative imposes on 52214 and 52001, bundling 52001 into 52214, Ferragamo says. "List 52001 first because it pays more than 52214."  
 
Look to 52648 for Laser Prostatectomy Post-TURP Question: Our surgeon performed a laser vaporization of the prostate two years after he performed a TURP for the same patient. Will Medicare allow us to bill 52648 two years after the carrier reimbursed [...]