Urology Coding Alert

The lack of a TURP code to represent the resection of residual obstructive tissue during the postoperative period continues to baffle urology coders and urologists but we've got the solution to this coding conundrum.                                   

Transurethral resection of the prostate (TURP) is a treatment used for patients presenting with benign prostatic hyperplasia (BPH), commonly referred to as enlarged prostate. BPH, a condition prevalent in men over the age of 50, is a condition of aging that can require surgical management if the symptoms and effects of the enlarged prostate become severe. BPH symptoms include, but are not limited to, frequent urination, overflow incontinence, hematuria, straining for urination, weak urine stream, and even acute urinary retention. The TURPcode descriptors include all sorts of indications for when the codes can be used and what other services are included in the codes, but they don't meet some very common TURPcoding needs.

The circumstances are familiar: Apatient undergoes a TURPon Monday and the urologist removes the catheter on Wednesday, but the patient is unable to void so the catheter is reinserted. The catheter is removed a second time on Friday, the patient is still unable to void, and the catheter is reinserted a second time. When the patient is still unable to void the following Monday, the urologist suspects residual obstructing tissue and schedules a cystoscopic examination and a possible additional transurethral resection procedure.

But there is no code for the resection of additional tissue in the postoperative period of TURP. You can't use 52620 (Transurethral resection; of residual obstructive tissue after 90 days postoperative) because, in the above example, the resection is performed before the global period has expired, says Joy Thebodeau, CPC, coding specialist for Spartanburg Urology Associates in South Carolina.

So, what should you do? Code Based on Status of Claim According to Michael A. Ferragamo, MD, FACS, clinical assistant professor at State University of New York, Stony Brook, the status of your claim can determine how you should approach coding the postoperative tissue resection.

Scenario 1: You have already submitted a claim for the initial TURPprocedure, using CPT 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]).

Code 52601 describes an initial, complete TURP procedure, includes vasectomy, meatotomy, cystourethroscopy, urethral calibration and/or dilation and internal urethrotomy and has a 90-day global period for all Medicare carriers and the vast majority of private carriers, says James R. Fishman, MD, a practicing urologist with Central Arizona Urologists in Phoenix. If you have [...]