Transurethral Resection of the Prostate (TURP)

• Document monopolar vs. bipolar and specific irrigant used. Monopolar requires electrolyte-free non-conducting solution (glycine 1.5%, sorbitol, or mannitol — not just glycine; each has different toxicity profiles). Bipolar uses normal saline. Document both choice and reason (bipolar eliminates hyponatremic TUR syndrome).
• Document verumontanum as distal resection landmark (prevents external sphincter injury and incontinence).
• Document gland volume (preoperative imaging) and estimated resected weight on pathology (supports medical necessity and completeness of resection).
• All prostate chips must be sent to pathology — incidental prostate cancer found in approximately 4-14% of TURP specimens. Document specimen sent.
• For monopolar cases, document resection time, irrigant type and approximate volume, and any signs of fluid absorption or TUR syndrome (hyponatremia, visual symptoms, bradycardia).
• {'Catheter traction hemostasis': 'document balloon volume and that traction was applied. Standard 3-way Foley balloon rated to 30 mL — do not overfill.'}

• 52601 (transurethral resection of the prostate, including control of post-operative bleeding, complete, 9.75 wRVU, 90-day global) covers complete electrosurgical TURP. The 90-day global includes all post-op catheter management, office cystoscopy, and routine follow-up.
• 52630 (transurethral resection of residual or regrowth of obstructive prostate tissue, 6.39 wRVU, 90-day global) applies when TURP is performed on a gland with prior resection. Document the prior TURP, approximate time since prior procedure, and current symptoms. If the repeat TURP is performed within the 90-day global period of the original, use modifier -78 (unplanned return to OR for a complication of the primary procedure). After the global period, bill 52630 alone.
• 52648 (laser vaporization of prostate, photoselective/GreenLight PVP, 9.80 wRVU, 90-day global) covers photoselective vaporization. 52649 (laser enucleation of prostate, HoLEP/ThuLEP, 12.68 wRVU, 90-day global) is for holmium or thulium laser enucleation. Do not bill 52648 for HoLEP — they are distinct procedures with distinct codes. CPT 52647 (laser coagulation of prostate) was deleted effective January 1, 2026; do not use 52647 on 2026 or later claims.
• 52450 (transurethral incision of the prostate, TUIP, 7.59 wRVU, 90-day global) is an alternative primary code for small glands (<30 g, no median lobe) — two incisions made without resection. It is mutually exclusive with 52601 (you cannot incise and resect in the same procedure). Bill 52450 only when incision alone is performed.
• Global period is 90 days (major). Bladder neck contracture requiring transurethral incision (52640, 4.67 wRVU) within 90 days of TURP uses modifier -78 if performed under anesthesia. Cystoscopy (52000) performed at the time of TURP for initial diagnostic evaluation is bundled; do not separately bill 52000.
• Open simple prostatectomy for large glands (typically >80-100 g, or when endoscopic approach is not feasible): 55821 (suprapubic prostatectomy, 1 or 2 stages) or 55831 (retropubic prostatectomy). Laparoscopic/robotic simple prostatectomy (added 2023): 55867. These replace open prostatectomy in many high-volume centers. Document gland weight — medical necessity for open simple prostatectomy requires gland size exceeding the threshold for safe endoscopic resection.
• Document gland weight/volume resected (grams on pathology). This supports medical necessity and differentiates complete from partial resection. All prostate chips must be sent to pathology — incidental prostate cancer is found in approximately 4-14% of TURP specimens.

General coding reference. Verify with your institution’s billing department before submitting claims.

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