Urology Coding Alert

Caution: Don't fall into the 'once in a lifetime' coding trapTransurethral resection of the prostate (TURP) procedures are commonplace in urology practices, but coding these surgeries is often anything but common. With five codes to choose from, you need to know the intricacies of TURP coding rules to ensure you pick the proper code in every situation. Let our experts give you the coding tools you need to hone your TURP knowledge.Start With 52601The first code most coders turn to when reporting TURP procedures is 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]).Important: "Code 52601 represents a 'once-in-a-lifetime' procedure which you can report only once per patient," says Michael A. Ferragamo, MD, FACS, clinical assistant professor of urology at the State University of New York, Stony Brook. "If the patient has already had a TURP procedure, you cannot use 52601 a second time, and you need to look at the other TURP codes.""The prostate gland can only be resected or removed once," explains Vickie Rhodes, CPC, billing and coding specialist for Greenwood Urological in South Carolina. "If the patient develops obstructive symptoms postoperatively it is considered residual tissue from the prostate, but there isn't an actual gland left to resect."Example: Your urologist sees a patient with frequent urination and hematuria, and the physician diagnoses 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 (BPH 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 the TURP procedure, you can't report them separately and, therefore, you should report only 52601.Remember: "Do not choose a TURP code based on the technique the urologist uses for the procedure or on the amount of prostatic tissue he removes," Ferragamo says. "If the physician does a channel TURP, for example, consider that simply a specific technique of the procedure, and report 52601."Timing Is Everything With Repeat TURPsIf your urologist does a TURP for a patient who has had a previous TURP, skip over 52601 and move right to 52620 (Transurethral resection; of residual obstructive tissue after 90 days postoperative) or 52630 (... of re-growth of obstructive tissue longer than one year postoperative). Use the length of time between the patient's previous TURP and the current procedure to differentiate between those two codes.The key: For a repeat TURP after the 90-day global period of the original or initial procedure, but less than one year [...]