Urology Coding Alert

Question: My urologist did a TURP for BPH (52601 for 600.01), and then the patient had to return to the operating room 21 days later for another TURP because of persistent BPH. The prostate was again noted as very large and vascular. The physician resected both sides again. He also noted that there may still be more tissue to excise at a later date.

What code should I use? I can't use 52620 because it's not after the 90-day global period. I can't use 52601 because it's a once-in-a-lifetime procedure. Should I use 52612 or 52614?


California Subscriber


Answer: You are correct in your coding statements. You already reported the first transurethral resection of the prostate (TURP) using 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]).

If the urologist stated that he thought the patient might require even further resections during the global period, you should code the second TURP as 52612 (Transurethral resection of prostate; first stage of two-stage resection [partial resection]). Append modifier 58 (Staged or related procedure or service by the same physician during the postoperative period) to indicate a staged procedure and ensure payment for the second TURP within the 90-day global of the first.

Pointer: You shouldn't use 52614 (Transurethral resection of prostate; second stage of two-stage resection [resection completed]) because that code indicates a "completed resection," which means you should use 52614 only if the urologist does not expect a subsequent resection within the global period.

For a repeated TURP after the first procedure's global period, you would report 52620 (Transurethral resection; of residual obstructive tissue after 90 days postoperative) for a second resection after 90 days and 52630 (... of regrowth of obstructive tissue longer than one year postoperative) for a second resection after one year.