Urology Coding Alert

Hint: There is an exception to the 'once in a lifetime' procedure mantra.

If your urologist still does transurethral resection of prostate (TURP) procedures -- even as a last resort after performing unsuccessful less invasive treatments -- you need to be sure your coding is up to date to make sure you bring in every dollar your urologist deserves.

Check out this advice from the experts to ensure you're coding TURP procedures properly.

Choose 52601 For First Procedure

If your urologist performs a TURP for a patient who has never had a TURP in the past, report 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]), explains Karla Dickerson, billing and reimbursement coordinator at Salina Urology Associates in Kansas.

Example: Your urologist sees a patient with frequent urination and nocturia and makes a diagnosis of 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 (Benign prostatic hyperplasia 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 a TURP procedure, you should not report them separately and, therefore, you should report only 52601.

Tackle Staged Procedures With Modifier 58

There may be times when your urologist preoperatively will consider staging a TURP or more likely while performing a TURP, determines during that surgery that the procedure cannot be completed at one sitting because of the excessive size of the prostate and operative time restraints. In either case he may determine that another TURP may be required within the global period of the first surgery. In this case, the physician should indicate in his operative report that the patient may require a second staged TURP. This documentation would then support a future claim for a subsequent staged TURP procedure.

Report 52601 for the first procedure, as noted above. Then, for the second staged procedure, report 52601 again. However, if the second surgery is planned as a staged procedure and occurs during the global of the first procedure, you should append modifier 58 (Staged or related procedure or service by the same physician during the postoperative period) to the second procedure, says Ruth Borrero, claims analyst at ProHealth Care, department of urology in Lake Success, N.Y.

"Modifier 58 is the key," agrees Ann Hayden, office manager at Urology Specialists in Phoenix. "Without it the insurance carrier will deny your second surgery."

Watch out: In the past, coders followed the rule that 52601 was a "once in a lifetime procedure," meaning you could only report a TURP once in a patient's life. This changed on Jan. 1, 2009 when CPT® updated the coding for a staged TURP.

Official guidance: CPT® states the following: "For first stage transurethral partial resection of prostate, use 52601. For second stage partial resection of prostate, use 52601 with modifier 58."

"I believe TURP coding to be easier now since the codes were revised/changed," says Dickerson.

Pay Attention to Patient History

When your urologist performs a resection for residual tissue or regrowth any time after the original TURP, you should report 52630 (Transurethral resection; residual or re-growth of obstructive prostate tissue including control of postoperative bleeding, complete [vasectomy, meatotomy, cystourethroscopy, urethral calibration and/or dilation, and internal urethrotomy are included]).

How it works: "A repeat TURP for residual or obstructive growth is coded as 52630, and [when performed] within a global [period of an initial TURP], add modifier 78 (Unplanned return to the operating/procedure room by the same physician following initial procedure for a related procedure during the postoperative period)," Borrero says.

Example: Your urologist is treating a patient who had prostatic surgery three years ago by another physician. The patient has had significant regrowth of prostatic tissue and is symptomatic. The urologist decides to perform a second TURP. Even though the work involved may be equivalent to an initial TURP, you should still report 52630, not 52601, because of the history of a prior TURP.

"Since a TURP has a 90-day global period, if you have to go back to the OR within the 90 day period due to residual prostate tissue, the code is 52630-78 but if the repeat procedure is past the 90 day initial post operative time frame the code is just 52630 by itself," Hayden explains.

Reminder: You should use 52630 only when your urologist performs a repeat TURP procedure following a previous initial TURP. If he uses another procedure to treat residual growth -- such as a laser prostatectomy (52648, Laser vaporization of the prostate, including control of postoperative bleeding, complete [vasectomy, meatotomy, cystourethroscopy, urethral calibration and/or dilation, and internal urethrotomy are included if performed or 52649, Laser enucleation of the prostate with morcellation ...), you will use these codes without a modifier.

Good practice: "I always review the most recent physician history and evaluation of the patient (i.e., past surgical history)," Dickerson says. "The patient may have had a previous TURP by another provider. Just because your account history doesn't show a previous billing for a TURP, doesn't mean it wasn't performed somewhere else. Sometimes the operative report can give you clues that there was a previous resection, but not always."

"For me, it is making sure I have the patient's complete prior urology history so I don't code 52601 when it should be 52630 because then my insurance payment is held up due to having to resubmit a corrected claim!" Hayden agrees. "Arizona is a big retirement state so lots of our patients are from elsewhere meaning they could have had a TURP10 years ago somewhere else and need a repeat today."