CPT® Code 0072T

1. Indications

The focused ultrasound ablation of uterine leiomyomata using CPT® Code 0072T is indicated for patients presenting with symptomatic uterine fibroids, specifically when the total volume of the leiomyomata is 200 cc or greater. This procedure is typically considered for individuals experiencing significant symptoms related to fibroids, such as heavy menstrual bleeding, pelvic pain, or pressure symptoms that impact their quality of life.

• Symptomatic Uterine Fibroids Patients with fibroids causing heavy menstrual bleeding, pelvic pain, or pressure symptoms.
• Total Leiomyomata Volume The procedure is specifically indicated when the total volume of the leiomyomata is 200 cc or greater.

2. Procedure

The procedure for focused ultrasound ablation of uterine leiomyomata involves several critical steps to ensure effective treatment. Initially, a three-plane localizer MR scan is performed to accurately position the patient on the treatment table. This step is essential for identifying the target fibroid and ensuring optimal alignment for the procedure. Following this, the treatment software is utilized to determine the appropriate treatment routes and settings for the ablation dose delivery. The physician reviews 3D renderings and dose simulations on the computer, which aids in planning the treatment strategy. Once the treatment plan is established, the procedure is conducted under conscious sedation, allowing the patient to remain awake and communicate any sensations experienced during the treatment. The physician, assistant, and patient all have access to an emergency shut-off button, ensuring safety throughout the procedure. Continuous MR imaging is employed during the sonication phase, where high-intensity focused ultrasound is directed at the leiomyoma. This process involves concentrating a high-energy beam on the fibroid tissue, raising its temperature to between 60-80 degrees Celsius, which effectively destroys the fibroid. If multiple leiomyomata are present, the procedure is repeated for each fibroid, including the steps of targeting, imaging, analysis, and destruction until all targeted leiomyomata are ablated.

• Step 1: MR Scan A three-plane localizer MR scan is performed to ensure proper patient positioning and identify the target fibroid.
• Step 2: Treatment Planning Treatment software is used to determine the appropriate treatment routes and ablation dose delivery settings, with 3D renderings and dose simulations reviewed.
• Step 3: Conscious Sedation The procedure is conducted under conscious sedation, allowing the patient to communicate sensations during treatment.
• Step 4: Emergency Protocol An emergency shut-off button is accessible to the patient, assistant, and physician to terminate the procedure if necessary.
• Step 5: Sonication Continuous MR imaging guides the high-intensity focused ultrasound to destroy the leiomyoma by raising its temperature to 60-80 degrees Celsius.
• Step 6: Repeat for Multiple Leiomyomata If multiple fibroids are treated, the targeting, imaging, analysis, and destruction process is repeated for each site until all leiomyomata are ablated.

3. Post-Procedure

Post-procedure care following the focused ultrasound ablation of uterine leiomyomata includes monitoring the patient for any immediate complications or adverse effects related to the treatment. Patients may experience some discomfort or mild pain in the treated area, which can typically be managed with over-the-counter pain relief medications. It is essential for patients to follow up with their healthcare provider to assess the effectiveness of the procedure and to monitor for any potential recurrence of symptoms. Additionally, patients are advised to report any unusual symptoms or complications, such as excessive bleeding or severe pain, to their healthcare provider promptly. Recovery time may vary, but many patients can resume normal activities shortly after the procedure, depending on their individual circumstances and the extent of the treatment.