Urology Coding Alert

Question: Which code should I use for holmium laser of a vesicle neck contracture?


Alabama Subscriber


Answer: Your coding for treatment of a bladder neck contracture (ICD-9 596.0 , Other disorders of bladder; bladder neck obstruction) by holmium laser depends on the etiology of the bladder neck contracture.

Option 1: If the bladder neck contracture is secondary to benign prostatic hypertrophy present predominately at the bladder neck, as often seen in younger men with obstructive symptoms, you should report 52450 (Transurethral incision of prostate) and append modifier 52 (Reduced services).

Code 52450 represents an incision of the prostatic urethra, usually extending from and including the bladder neck to the verumontanum, the complete prostatic urethra. Adding modifier 52 indicates a reduced service, in this case an incision only at the bladder neck. You can use this code and modifier for any number of incisions at the bladder neck using any technology, such as a hot or cold knife, resectoscope loop, or laser incision as referred to here. Option 2: If the bladder neck contracture is secondary to a previous prostate surgery, such as an overzealous transurethral resection of the prostate [TURP] at the bladder neck, you'll instead use 52640 (Transurethral resection; of postoperative bladder neck contracture). Again, you should apply modifier 52 to indicate that the urologist performed an incision(s) only at the bladder neck.

Option 3: If the bladder neck contracture occurs after a radical prostatectomy, which is in fact a urethral stricture at the vesicourethral junction, you should report 52276 (Cystourethroscopy with direct vision internal urethrotomy). You don't need to append modifier 52 in this case because the code represents the procedure the urologist performed and there's no reduced service. Code 52276 represents a straightforward cutting of the stricture.

Note: You should use the above codes for any type of therapy and technology used for treating the bladder neck contracture, whether a laser, hot knife, cold knife or a single resection groove.