february 2012

Treatment of Benign Prostatic Hyperplasia (BPH)

Benign prostatic hyperplasia is an enlargement of the prostate gland which puts pressure on the urethra causing numerous urinary symptoms such as urinary retention, incontinence or nocturia to name a few.  BPH alone is not a precursor to cancer, but there are instances where malignant neoplasm(s) may cause enlargement of the prostate and in those instances the physician would be treating the malignancy and not BPH.  For the purpose of our discussion we will be reviewing the treatment methods used to combat urinary symptoms.  Transurethral resection of prostate tissue (TURP) is one of the more common treatments for BPH.  Some of the procedures coders may not be familiar with include the use of laser and microwave or radiofrequency energy. 

CPT Code 52647 – Laser coagulation of prostate tissue.  This type of procedure is termed a “non-contact” laser procedure because the laser tip never touches the prostate itself.  Other terms you can look for as keywords would be VLAP (visual laser ablation of prostate) or “coagulation necrosis”.  When heat is used in a non-contact application it causes tissue coagulation leading to cell death.  The remaining non-viable necrotic tissue separates and falls away from the viable tissue in a process called sloughing.  This code is intended to describe all procedures that primarily heat the prostate tissue and require sloughing for the treatment to be complete.

CPT Code 52648 – Laser vaporization of prostate tissue.  This type of procedure is termed a “contact” laser procedure because a contact tip or high-power density laser is used to immediately vaporize any tissue that it comes into contact with.

CODING TIPS — When coagulation (52647) is performed, an” incision or small amount” of vaporization does not change the coding – 52647 is still reported as the primary procedure. ·         The language included in the code descriptors for these procedures does not limit use of the code to any specific type or name brand of laser device that may be used.

CPT Code 53850 – Transurethral destruction of prostate tissue using microwave thermotherapy (TUMT).   Microwave energy is another type of heating process but its application of selective destruction allows for a more focused area of treatment that delivers therapeutic levels of heating to sufficiently destroy the deeper prostate tissue while not causing unnecessary damage and preserving surrounding structures.

CPT Code 53852 – Transurethral destruction of prostate tissue using radiofrequency thermotherapy (TUNA).  Radiofrequency needle pierces the urethral wall and is advanced into the prostate tissue.  These needles have an insulated covering with an exposed tip.  Once the tip is in place radiofrequency energy is applied causing coagulation and tissue necrosis of the prostate (insulated covering protects the urethral wall).  Destroyed tissue is reabsorbed into the body shrinking the size of the prostate.