Urology Coding Alert

Question: My physician documented that he performed “photoselective vaporization of the prostate using green-light laser” for a patient with urinary retention. Should I code this using 52648?


California Subscriber


Answer: Although 52648 (Laser vaporization of prostate, including control of postoperative bleeding, complete [vasectomy, meatotomy, cystourethroscopy, urethral calibration and/or dilation, internal urethrotomy and transurethral resection of prostate are included if performed]) is an appropriate code for the green-light laser procedure, you have another problem.
 
Remember: The diagnosis indicating the medical necessity for the green-light laser procedure must be BPH with obstruction (600.01, Prostatic hyperplasia)

 

For ICD-10, report N40.1 (Enlarged prostate with lower urinary tract symptoms).

Urinary retention (788.20, Retention of urine, unspecified) or in ICD-10 R33.9 (Retention of urine, unspecified) is not considered a viable diagnosis that proves medical necessity for the green-light laser procedure. Therefore, payers will likely deny your claim based on that diagnosis.