Introduction

Current Procedural Terminology (CPT) code 52601 describes Transurethral electrosurgical resection of prostate, including control of postoperative bleeding, complete (vasectomy, meatotomy, cystourethroscopy, urethral calibration and/or dilation, and internal urethrotomy are included), also known as a “TURP” procedure. It is important to understand what the code descriptor means for accurate coding and billing. To bill CPT 52601, the amount of tissue removed should be the maximum that is reasonable and necessary in an attempt to improve a patient’s voiding parameters typically in 1 procedure (unless a 2-stage procedure is planned in advance due to prostate size). One does not need to perform a complete removal of all prostate tissue, but the surgeon should do their best to remove as much tissue as possible and reasonable. The parenthetical serves to describe which procedures cannot be billed separately if performed at the same time as a TURP but none are needed to be performed to bill the code without the need for a reduced services modifier.

History

Originally there were 5 CPT codes used to report TURP procedures:

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)

52612 Transurethral resection of prostate; first stage of two-stage resection (partial resection)

52614 Transurethral resection of prostate; second stage of two-stage resection (resection completed)

52620 Transurethral resection; of residual obstructive tissue after 90 days postoperative

52630 Transurethral resection; of regrowth of obstructive tissue longer than one year postoperative

There are currently 2 CPT codes, with code descriptors and parentheticals as noted:

CPT 52601 Transurethral electrosurgical resection of prostate, including control of post operative bleeding, complete (vasectomy, meatotomy, cystourethroscopy, urethral calibration and/or dilation, and internal urethrotomy are included) (52612, 52614, 52620 have been deleted. For first stage transurethral partial resection of prostate, use 52601. For second stage partial resection of prostate, use 52601 with modifier 58. For transurethral resection of residual or regrowth of obstructive prostate tissue, use 52630)

CPT 52630 Transurethral resection; residual or regrowth of obstructive prostate tissue, complete (vasectomy, meatotomy, cystourethroscopy, urethral calibration and/or dilation, and internal urethrotomy are included)

(For resection of residual prostate tissue performed within the postoperative period of a related procedure performed by the same physician, append modifier 78)

CPT codes 52612 and 52614 were used to report 2-stage TURP procedures if the prostate was too large to accomplish the resection goals in 1 procedure, using CPT 52612 to report the first stage (an “incomplete” TURP) and CPT code 52614 the second stage (appended with modifier 58 if needed). The word “complete” was therefore included in CPT code 52601 to describe the intent of the surgeon to complete the resection in 1 procedure rather than 2, not to describe completeness of tissue removal. CPT codes 52612 and 52614 have since been deleted, along with the addition of parentheticals to CPT codes 52601 and 52630. The parentheticals note that CPT 52601 should be used for the first stage resection (no modifier needed) if there was a planned 2-stage procedure with CPT code 52601 also being used for the second stage using modifier 58. In contrast, CPT 52630 would be used to report the second stage procedure if unplanned. Note that the Centers for Medicare & Medicaid Services has rules that CPT 52601 is a “once-in-a-lifetime” procedure, so CPT 52630 would be reported for the second stage TURP whether planned or unplanned.

CPT codes 52620 and 52630 described resection of residual obstructive tissue after 90 days postoperative or >1 year postoperative, respectively. As these codes also led to some coding confusion and were deemed to have overlap and redundancy, CPT code 52620 was later deleted and the code descriptor of 52630 was modified to match that of CPT 52601; a parenthetical with coding guidance was also added.

Question 1: Does “All of the Prostate Tissue” Need to be Removed to Bill CPT 52601 to Satisfy the Word “Complete” in the Descriptor?

No. The meaning of the word “complete” in CPT 52601 implies that the surgeon is attempting to complete the resection in 1 setting instead of a planned 2-stage procedure, where the first stage was known to be incomplete. It was not intended to describe the completeness of the tissue removal. CPT code 52601 should be reported (without a modifier) any time a patient is brought to the operating room with the goal of removing as much prostate tissue as reasonable to improve patient voiding parameters. Note that it may even take more work to remove more tissue in a patient with a larger gland than all of the tissue in a patient with a smaller gland, yet both still meeting patient outcome goals.

It is critical that surgeons are honest and accurate in their reporting, appending modifier 52 when appropriate. Examples may include performing a limited “channel TURP,” resection of prostate due to a prostatic abscess, or removal of a mass. Please note that the use of a reduced services modifier in these cases is still up to the discretion of the surgeon, and the use of a modifier is not necessary merely because of the indication for the procedure. If the surgeon believes that the amount of tissue resected and the amount of work performed was significant enough to report CPT 52601 without a modifier, it is within their expertise and clinical judgment to do so. The surgeon’s notes should reflect this.

Question 2: Do the Procedures within the Parenthetical Need to be Performed to Bill CPT 52601?

No. The parentheticals after CPT codes 52601 and 52630 are written in a way to describe procedures that are included if performed but are not needed to be performed to bill the code unmodified.

Conclusion

CPT code 52601 can be reported (without a modifier) when a surgeon removes as much tissue as is reasonable and necessary in an attempt to improve a patient’s voiding parameters. There are no requirements with respect to a minimum or maximum amount of tissue needing to be resected. None of the procedures listed in the parenthetical may be billed separately if performed at the same time, yet none of the procedures listed in the parenthetical need to be performed to report CPT 52601 unmodified. Surgeons need to be honest about their reporting and work performed and should append modifier 52 when appropriate.