Urology Coding Alert

Question: My urologist started a photoselective vaporization of the prostate (PVP) and then converted it to a transurethral resection of the prostate (TURP). He thinks that he should be able to append modifier -53 (Discontinued procedure) to the PVP and code for the TURP and get reimbursement for both. Is he right?

Indiana Subscriber

Answer: No, your urologist is overlooking some important coding rules. You should report the TURP with 52601 (Transurethral electrosurgical resection of prostate, including control of postoperative bleeding, complete), and the National Correct Coding Initiative prevents you from also reporting the PVP with 52648 (Contact laser vaporization with or without transurethral resection of prostate, including control of postoperative bleeding, complete).

Although code 52648 contains "with or without transurethral resection of the prostate," this indicates a transurethral resection of the prostatic adenoma using the laser probe. In this particular case it appears that the PVP procedure could not be accomplished and was instead replaced by a formal electrosurgical TURP procedure. The TURP constituted a complete and more invasive procedure.

"An initial approach to a procedure may be followed at the same encounter by a second, usually more invasive approach," the National Correct Coding Policy Manual states. "There may be separate CPT codes describing each service. The second procedure is usually performed because the initial approach was unsuccessful in accomplishing the medically necessary service; these procedures are considered 'sequential procedures.' Only the CPT code for one of the services, generally the more invasive service, should be reported." In this case, that means you report code 52601 and forget about 52648.