Worried about payers denying your claims for a particular prostate removal procedure? Use CPT code 52648 if you have performed laser vaporization of the prostate (LVP). We all know that Benign Prostatic Hyperplasia (BPH) is a common issue among older men. Specifically, it affects 70% of the male population aged 60-69 years and 80% of those older than 70.
Hence, prostate surgeries are common all over the U.S. Among these, laser procedures, such as prostate coagulation, vaporization, and enucleation, are quite popular in urology. Their coding, however, is so challenging that even experienced urology coders struggle to capture everything accurately.
Are you also unable to differentiate between these codes? Don’t worry, as today we will be covering one of them (the 52648 CPT code) in detail.
CPT Code 52648 – Description
So, which prostate procedure does this code cover? CPT code 52648 specifies a minimally invasive laser technique for removing excess prostate tissue. To be more specific, it refers to the contact laser vaporization of the prostate, also known as photoselective vaporization of the prostate (PVP). So, what happens during this procedure?
A urologist adopts a transurethral approach to perform this minimally invasive procedure, meaning he inserts a fiber-optic scope through the urethra to reach the patient’s prostate. He then inserts the laser probe through this scope to vaporize the enlarged prostate tissue. The primary purpose of LVP? To address all the lower urinary tract problems caused by BPH.
In short, the 52648 CPT code represents a laser surgery to remove prostate tissue. It also covers all the steps taken to control post-operative bleeding and the following related procedures if they are performed during the same session:
- Vasectomy
- Meatotomy
- Cystourethroscopy
- Urethral Calibration and/or Dilation
- Internal Urethrotomy
Scenarios Where CPT Code 52648 is Applicable
Still confused about meeting this code’s requirements? Here are three coder-friendly scenarios to help you understand CPT code 52648 better:
Laser Vaporization for BPH in a Patient with a Bleeding Disorder
While benign prostatic hyperplasia is more common in older men, it can affect about 45% of men over age 45. In this example, suppose a 47-year-old man visits a urology clinic with one complaint: difficulty in urinating.
After evaluation, the provider decides that laser vaporization is the safest treatment option. The main reason? The patient has a bleeding disorder, making the standard transurethral resection of the prostate (TURP) procedure inappropriate.
The urologist performs laser vaporization of the prostate via a transurethral approach and uses CPT code 52648 to accurately capture the service.
PVP to Address Lower Urinary Tract Symptoms
Photoselective laser vaporization is a much safer and efficient procedure than TURP for treating lower urinary tract symptoms due to BPH. So, for this example, let’s consider an 80-year-old high-risk cardiac patient with an enlarged prostate.
He arrives at a urology clinic after failed medication treatment. The urologist evaluates the patient and opts for laser vaporization to destroy the enlarged tissue due to minimal risks. He then uses CPT code 52648 to report the procedure.
Laser Vaporization for BPH-Related Gross Hematuria
Untreated BPH can cause gross hematuria (visible blood in the urine) among older men. However, these cases are very rare. For this scenario, let’s consider a 75-year-old man with long-standing BPH. He arrives in the emergency department after noticing blood in his urine for a week.
The healthcare provider conducts a thorough evaluation and orders several diagnostic tests to identify the root cause of this gross hematuria. The test results reveal a significantly enlarged prostate as the source of bleeding and obstruction.
The emergency physician then refers the patient to a urologist, who removes the obstructing tissue and controls bleeding via transurethral laser vaporization. His billing team then uses CPT code 52648 to file a claim for this contact LVP.
Applicable Modifiers for CPT Code 52648
Want to provide additional, specific details about the laser vaporization of the prostate? You can use the following modifiers with CPT code 52648:
Modifier 53
Did you stop the LVP due to some complications? If the procedure was stopped after anesthesia administration, you can use modifier 53 with CPT code 52648 to report this information.
Modifier 59
The laser vaporization of the prostate was not the only procedure you performed on that patient? If the procedure was distinct from other services you delivered on the same day, append modifier 59 to CPT code 52648 to request separate payment.
CPT Code 52648 – Billing & Reimbursement Guidelines
Want to speed up your reimbursements for LVP? Simply follow these billing guidelines for CPT code 52648:
Use CPT Code 52648 for LVP
We have already clarified what this code covers in its description, but we don’t want you to make the same mistake as many others do. To reiterate, CPT code 52648 covers a minimally invasive procedure where a urologist uses a laser to vaporize (destroy) part of the prostate.
In simple terms? It points towards the LVP technique that addresses problems caused by benign prostatic hyperplasia. Hence, avoid using this code for other laser procedures, such as coagulation of the prostate or HoLEP.
Do Not Bill Separately for Related Procedures
CPT code 52648 already covers all the related procedures, such as vasectomy, meatotomy, cystourethroscopy, and internal urethrotomy. Therefore, avoid billing these services with separate codes if you have performed them within the same session as laser vaporization of the prostate.
Understand Global Billing Rules
Although minimally invasive, LVP is a major surgical procedure. Hence, it has a global period of 90 days. You should check each payer’s policy to confirm what pre- and post-operative services are included in the global package for this procedure, to avoid billing mistakes.
Verify Coverage & Justify Medical Necessity with Documentation
Before performing the procedure, you must verify whether the patient’s insurance plan covers laser vaporization for BPH. If it does, then make sure to document this surgery thoroughly. This includes recording the following information:
- Issues faced by the patient due to BPH (difficulty in urination, incomplete urination, or some other problem)
- Prostate size
- Procedural details (approach, scope, and laser type)
- Post-operative findings and complications
Summary
Use CPT code 52648 confidently if you have performed contact laser vaporization of the prostate. Just keep one thing in mind! This code covers related prostate procedures. So, avoid the common mistake of billing them separately. We have everything about the 52648 CPT code, so you don’t confuse it with other similar options, especially CPT code 52647.
But if our guide isn’t enough and you are still struggling with recurrent denials, you can file your claims through a trusted billing partner. Many companies, including MediBillMD, offer cost-effective and reliable urology billing services. So, choose an expert and maximize your revenue.
