Medical necessity must be documented on the chart in order to bill code.
I read the article “What is included in the global period for TURP?”1 The article stated that the urinary catheter is included. Can you please also note whether 51798 is included? I read a post on a coding website that says that 51798 is considered diagnostic and not therapeutic, so it can be billed during the global period. Can you please confirm this?
Common Procedural Terminology (CPT) 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]) is assigned a 90-day global by Medicare. A 90-day global procedure means that the work for the procedure and associated care have already been factored into the payment for the code, typically including 1 day preoperative work, work on the day of the procedure, and the work that is typical for 90 days beginning the day after surgery.
What we did not include in our previous article are services not part of the global surgical package. The list of services notincluded in the global of a major surgery like a transurethral resection of the prostate (TURP) include the initial evaluation of the problem resulting in the decision for surgery, services of other physicians, visits unrelated to the diagnosis unless it is a complication, treatment of an underlying condition, diagnostic tests and procedures (including postvoid residual [PVR]), distinct surgical procedures that are not reoperations or for complications, treatment of complications requiring a trip to the operating room, and a more extensive surgery due to failure of the initial surgical treatment.
However, the important question is not whether it is a billable service, but whether there is medical necessity for the service. There is no medical necessity to performing a PVR on a patient during the normal recovery from a TURP merely because the patient arrives for a visit. If there is medical necessity documented on the chart, such as a patient who presents with symptoms concerning for urinary retention, CPT 51798 can be billed if performed.
Rubenstein is compliance officer and medical director of coding and reimbursement, United Urology Group and Chesapeake Urology, Towson, Maryland. Painter is CEO of PRS Urology SC in Denver, Colorado.
1. Rubenstein J, Painter M. What is included in global period for TURP? Urology Times®. March 18, 2020. Accessed March 9, 2021. https://www.urologytimes.com/view/what-included-global-period-turp
Send coding and reimbursement questions to Rubenstein and Painter c/o Urology Times®, at firstname.lastname@example.org.
Questions of general interest will be chosen for publication. The information in this column is designed to be authoritative, and every effort has been made to ensure its accuracy at the time it was written. However, readers are encouraged to check with their individual carrier or private payers for updates and to confirm that this information conforms to their specific rules.