Wiki Limited TURP?

greendm

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Looking for assistance for a code for: A 20-French UroLift cystoscope was advanced transurethrally without any difficulty. The bladder and prostate anatomy was evaluated, findings are noted in the findings section. UroLift implants were placed within the prostatic fossa in an appropriate location far enough from the bladder neck and the sphincter, implants were placed on either side as described in the procedure findings section to achieve the most optimal result possible.

I then noticed as a inform the patient preoperatively that the mild adenoma at the ventral aspect of the bladder neck and proximal third of the gland did partially obstruct that portion of the fossa. Given best results, as I discussed with him preoperatively, I proceeded to perform a very limited resection of that adenoma. I switched to a continuous flow apparatus and inserted into the bladder without difficulty with a visual obturator. I used the bipolar loop to take about 5 swipes of small chips to address just enough of that tissue without resecting the deep. I did this to both achieve the best result but also to avoid resection of the bladder neck to maintain or give best chance of maintaining antegrade ejaculation. Minimal cautery was done and resected area to achieve good hemostasis. No injuries to the bladder or prostate fossa. UroLift implants were in good position. The fossa was wide open at this point with very good visual results. No cautery in the distal half of the gland or near the Vero.
Thank you
 
I asked this same question a while back. This answer was from Dr. Ferragamo: "This is a clinical scenario in which two procedures are performed to accomplish one end result, opening the prostatic urethra to help in voiding. In these situations the CPT rules tell us to bill the one procedure that most accomplishes the end result and not the two procedures. In this clinical case I would choose the urolift alone as being the most to reach the end result."
 
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