Repeat Greenlight

Jessim929

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Hi all -

I hope someone can shed a little light here.... We have a patient who had two Greenlight vaporizations of prostate (52648) about fifteen months apart. The dictation does not indicate it was a staged procedure. I can not find any documentation that clearly indicates that 52648 is a once in a lifetime procedure, which leads me to believe that it's a policy of Humana to make it a once in a lifetime. So, before we bill the patient, I want to exhaust every option to get the insurance to cough up the cash.
Is 52649 a subsequent Greenlight in the same way the 52630 is a subsequent 52601? OR is there another code to use? OR is there definitive documentation to say one way or another on the once in a lifetime thing? Does anyone have any suggestions on what to say in the appeal?

Thank you for all the help!!
 

michelleaapc2012

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This is a good question! I would like clarification as well. I was taught from a mentor that the resection itself is a once in a lifetime procedure 52601 OR 52648. SO any repeat procedure afterwards would be reported 52630.
 

Jessim929

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This is a good question! I would like clarification as well. I was taught from a mentor that the resection itself is a once in a lifetime procedure 52601 OR 52648. SO any repeat procedure afterwards would be reported 52630.
But everything I found said 52630 is only used after 52601, NOT 52648. And I was taught that 52648 isn't a once in a lifetime code.
 

michelleaapc2012

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But everything I found said 52630 is only used after 52601, NOT 52648. And I was taught that 52648 isn't a once in a lifetime code.
That's why I would like someone else to clarify. I know that I have billed 52648 more than once for the same patient and insurance denied. I had to resubmit with the repeat code 52630.
 

michelleaapc2012

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But everything I found said 52630 is only used after 52601, NOT 52648. And I was taught that 52648 isn't a once in a lifetime code.
I just found this from an older post:
drewvinson23
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Aug 9, 2018
Your office manager is correct in this case.

Here is an excerpt from a Urology Coding Alert dated 3/20/18:

"Sometimes the urologist will use another procedure to treat residual growth after an initial TURP, such as laser prostatectomy (52648, Laser vaporization of the 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 or 52649, Laser enucleation of the prostate with morcellation ...). If so, you should report the appropriate code for one of the laser procedures above, not the “second repeat TURP” code 52630 (Transurethral resection; residual or regrowth …)."

Hope this helps.

Sincerely,

Drew Vinson
CPC
NW Urology

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Jessim929

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So if I'm reading this correctly, after a 52601 the doctor can do EITHER a 52630 OR 52648. And after a 52648, if they go back with the Greenlight, it should be a 52649?

Just want it to make sense in my words. :)

Thanks!!
 

sxcoder1

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52649 is not a laser vaporization, it is a laser enucleation which is different. If a laser procedure is done, you code the laser cpt code whether it's the first one or a repeat. 52630 is for a transurethral resection for regrowth.
 

Jessim929

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52649 is not a laser vaporization, it is a laser enucleation which is different. If a laser procedure is done, you code the laser cpt code whether it's the first one or a repeat. 52630 is for a transurethral resection for regrowth.
I had a feeling the 52649 was not a direct match to the 52648. Thank you for clearing that part up.
So, 52648 is NOT a once in a lifetime code - unless the insurance company dictates such, correct?
 
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