Urology Coding Alert

Question: A TURP (transurethral resection of prostate, CPT code 52601 is started but after 10 minutes it is discontinued because of low blood pressure. Four days later the TURP is then done without problems. How do you code for the first TURP and the one completed four days later? Suppose the first urologist goes on vacation and another urologist does the repeat TURP. How do you code for that second one?

New York Subscriber

Answer: It depends on how far into the TURP the physician got before the procedure was terminated. If the procedure was terminated after administration of anesthesia, modifier -53 (discontinued procedure) is attached to CPT code 52601 (transurethral electrosurgical resection of prostate, including control of postoperative bleeding, complete). However, if the physician completed any components of the TURP, e.g., vasectomy, cysto with dilation, etc., the code(s) for the service(s) completed would be reported without modifier -53.

Technically, when modifier -53 is reported the service should be removed from a global period with no follow-up days. The successful TURP several days later may then be reported without a modifier. However, some payers may interpret the modifier differently. Modifier -53 may not affect global surgery guidelines defined by the individual payer. In that case, modifier -58 (staged or related procedure or service by the same physician during the postoperative period) would be reported in addition to the code for the completed TURP.

If other CPT codes were used to report the completed services in the first attempt, the global periods assigned to those services would be in effect. If there is a global period, modifier -58 would again be appended to code 52601.

When the second urologist is from the same practice and billing under the same provider number, he/she would code his/her services as the original urologist would have (i.e., modifier -58). If the second urologist is from a different practice, he/she is not affected by global periods from the original urologist's surgery. No modifier would be required for his/her services.