Summary & Overview
CPT 52630: Resection of Residual or Regrown Prostate Tissue
CPT code 52630 denotes surgical resection of residual or regrown prostate tissue following a prior resection. This procedure is clinically important for patients with persistent or recurrent obstructive prostate tissue after earlier surgery and can affect downstream care needs, resource utilization, and surgical planning. Nationally, management of recurrent prostate tissue has implications for surgical capacity and payer coverage policies.
Key payers addressed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of the clinical intent of the code, common sites of service, and the payer landscape covered in the analysis. The publication summarizes benchmarks for utilization and reimbursement patterns where available, highlights relevant policy considerations for coverage and prior authorization, and situates the code within urologic surgical care pathways. Clinical context includes indications for re-resection, typical operative settings, and how this code relates to management of recurrent or residual prostate tissue.
Data not available in the input will be noted where applicable in detailed sections. The content is designed for clinicians, billers, and policy stakeholders seeking a concise national view of CPT code 52630 and its role in urologic surgical care.
Billing Code Overview
CPT code 52630 describes a surgical procedure to resect residual or regrown prostate tissue after a prior prostate resection. The service type is a urologic reoperative prostate tissue resection. The typical site of service is an operating room or ambulatory surgical center where operative management of the prostate is performed.
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 68-year-old male with a history of prior transurethral resection of the prostate (TURP) presents with recurrent lower urinary tract symptoms (LUTS), hematuria, and obstructive voiding after several years of symptomatic relief. Workup includes digital rectal exam, prostate-specific antigen testing, urinalysis, uroflowmetry, and transrectal ultrasound demonstrating residual adenomatous tissue and regrowth within the prostatic fossa. The urologist schedules a repeat transurethral resection targeting residual/recurrent obstructive tissue. The procedure is performed in an outpatient surgical center or hospital operating room under regional or general anesthesia with cystoscopic visualization and resection of remaining prostatic adenoma. Postoperative care includes short-term catheterization, monitoring for bleeding and urinary retention, and follow-up for symptom improvement and PSA surveillance.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
51 | Multiple procedures | When other unrelated procedures are performed at the same operative session in addition to the repeat prostate resection. |
| 52 | Reduced services | When the service is partially reduced or not completed as planned (e.g., limited resection due to intraoperative findings).
| 53 | Discontinued procedure | When the procedure is started but halted due to a complication or patient instability prior to completion.
| 59 | Distinct procedural service | Data not available in the input.
| 62 | Two surgeons | When two surgeons work together as primary surgeons on different portions of the procedure.
| 78 | Return to OR for related procedure during global period | For an unplanned return to the operating room for related treatment of a complication.
| 79 | Unrelated procedure or service by same physician during postoperative period | When an unrelated procedure is performed during the global period from the index surgery.
| 26 | Professional component | When only the professional component of a service is billed separately (rare for operative codes but applicable to certain adjunct services).
| TC | Technical component | When only the facility/technical component is billed (used for imaging or diagnostics associated with the case).
| GC | Service is performed in part by a resident under a teaching physician | When a resident participates and the teaching physician performs portions as required for billing.
| Taxonomy Code | Specialty | Notes |
|---|---|---|
208800000X | Urology | Primary specialty performing transurethral prostate procedures. |
| 208D00000X | General Surgery | May perform urologic procedures in some settings, though less common for TURP-type resections.
| 207L00000X | Obstetrics & Gynecology | Data not applicable; gynecology not typical for this procedure.
| 363LP0800X | Surgical Oncology | May be involved if malignancy suspected or for complex reoperative pelvic surgery.
| 2080P0208X | Female Pelvic Medicine & Reconstructive Surgery | Not typically applicable to male prostate procedures, included for completeness.
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
N40.0 | Enlarged prostate with lower urinary tract symptoms | Common indication for resection of residual or regrown prostatic tissue causing obstruction. |
| N40.1 | Benign prostatic hyperplasia without lower urinary tract symptoms | BPH that may have previously been treated and can show regrowth necessitating repeat resection if symptomatic.
| R33.8 | Other retention of urine | Urinary retention due to residual obstructive tissue prompting reoperation.
| R33.0 | Retention of urine, unspecified | Acute or chronic retention presentation leading to the need for resection.
| N42.89 | Other specified disorders of prostate | Includes other prostatic conditions (e.g., fibrosis, recurrent adenoma) that may require resection.
| N02.9 | Recurrent hematuria, unspecified | Hematuria from prostatic tissue regrowth or residual adenoma occasionally mandates repeat resection.
| C61 | Malignant neoplasm of prostate | When malignancy is present or suspected, resection may be therapeutic or diagnostic in select cases.
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
52601 | Transurethral electrosurgical resection of prostate, single lobe | An alternative initial resection code for primary TURP procedures; may represent prior surgery whose residual tissue is now resected with 52630. |
| 52612 | Transurethral electrosurgical resection of prostate, with control of postoperative hemorrhage | Related when significant bleeding requires additional intraoperative control or reoperation.
| 55700 | Biopsy, prostate; needle or punch, single or multiple, any approach | May be performed preoperatively to evaluate for malignancy prior to repeat resection.
| 52000 | Cystourethroscopy, with or without ureteral catheterization, with or without irrigation and/or calibration of urethra | Diagnostic endoscopic evaluation often performed before or during transurethral resection.
| 52634 | Transurethral resection of ejaculatory ducts | Performed when pathology involves the ejaculatory ducts or adjacent structures during prostate procedures.