Urology Coding Alert

Question: A patient had had a prior TURP, and the diagnosis was a post-op bladder neck closure. The urologist pushed a cystoscope through the contracture, dilating it. He examined the bladder, passed a green light laser fiber through the scope and incised the bladder neck stricture at three positions. I've looked at CPT 52640 and 52648. What's the right code?


Indiana Subscriber


Answer: Although 52640 (Transurethral resection; of postoperative bladder neck contracture) describes a complete circumferential resection of the bladder neck, it is the closest description of the procedure your urologist performed.

Since the urologist did not perform a full transurethral resection of the bladder neck contracture, append modifier -52 (Reduced services) to 52640 to indicate that he did not do the complete service described in the code, but did open the bladder neck contracture with individual incisions into the bladder neck.

You may use code 52640 appended with modifier -52 to report any method the urologist used to incise the postoperative bladder neck contracture, including hot cutting, cold cutting, or - as in this case - laser incision.

Code 52648 (Contact laser vaporization with or without transurethral resection of prostate, including control of postoperative bleeding, complete [vasectomy, meatotomy, cystourethroscopy, urethral calibration and/or dilation, and internal urethrotomy are included]) describes a full vaporization of prostatic tissue, prostatic adenoma - not an incision of the bladder neck.

For a primary bladder neck contracture (localized BPH at the bladder neck), incised with the laser, report 52450-52 (Transurethral incision of prostate; reduced services).