Commentary
Article
How to bill for placement of a peri-rectal spacer
Author(s):
"Please note that although this starts out as a balloon rather than just the injection of a biodegradable product, this device is actually fully biodegradable and is absorbed within 6 months of insertion," write Jonathan Rubenstein, MD, and Mark Painter.
I am thinking of using the BioProtect peri-rectal spacer for a patient scheduled to undergo radiation therapy for prostate cancer. What is the correct code to report the insertion of the device? Is it OK to use 55874?
Jonathan Rubenstein, MD
The BioProtect Balloon Implant System is a rectal spacer system like other rectal spacers that are used to help protect the rectum during radiation therapy for prostate cancer. As with all the products in this space, the goal of the procedure is to reduce the radiation dose that may affect the anterior rectum. Like other products, the BioProtect Balloon Implant is placed into the space between the prostate and rectum through a small transperineal incision and placed under ultrasound guidance. After the balloon is placed, it is then filled with saline.
Mark Painter
As this is a balloon, the question has come up on whether it would be appropriate to report Current Procedural Terminology (CPT) code 55874 (Transperineal placement of biodegradable material, peri-prostatic, single or multiple injection[s], including image guidance, when performed)for placement of this product.
Please note that although this starts out as a balloon rather than just the injection of a biodegradable product, this device is actually fully biodegradable and is absorbed within 6 months of insertion. Therefore, due to basically the same procedure for placing this peri-prostatic product under the same imaging guidance and the fact that this product is fully biodegradable, it would be appropriate to report CPT 55874 for this procedure.
Send coding and reimbursement questions to Jonathan Rubenstein, MD, and Mark Painter c/o Urology Times®, at UTeditors@mjhlifesciences.com.
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.
