CPT® Code 53865

Official Description

Cystourethroscopy with insertion of temporary device for ischemic remodeling (ie, pressure necrosis) of bladder neck and prostate

Common Language Description

The procedure described by CPT® Code 53865 involves cystourethroscopy with the insertion of a temporary device aimed at ischemic remodeling of the bladder neck and prostate. This procedure is typically indicated for patients suffering from an enlarged prostate, which can lead to lower urinary tract symptoms. The temporary device serves as an alternative treatment option to more invasive procedures such as transurethral resection or other methods that involve the destruction of prostate tissue. The device itself is constructed from a biocompatible super-elastic shape memory alloy known as nitinol, which allows it to adapt to the anatomy of the patient while minimizing tissue damage. The device is designed to be left in place for a duration of five to seven days, during which it applies gentle pressure to reshape the prostatic urethra at the bladder neck level. This reshaping process aims to widen the urethra, facilitating improved urine outflow without the need for thermal destruction or removal of any tissue. The procedure is performed using a rigid cystourethroscope, which is inserted through the urethra and advanced into the bladder for inspection. Following the initial inspection, the cystoscope is removed, and the endoscopic sheath remains in place to facilitate the deployment of the temporary remodeling device. The precise positioning of the device is critical to ensure optimal outcomes while avoiding damage to the sphincter and preventing device migration. After the designated period, the device is removed in a separate procedure under local anesthesia, ensuring that the patient experiences minimal discomfort and a streamlined recovery process.

1. Indications

The procedure described by CPT® Code 53865 is indicated for the following conditions:

Enlarged Prostate The procedure is performed for patients with benign prostatic hyperplasia (BPH) that leads to lower urinary tract symptoms, which may include difficulty urinating, frequent urination, or a weak urine stream.

2. Procedure

The procedure begins with the insertion of a rigid cystourethroscope through the urethra, which is then threaded up into the bladder. This initial step allows for a thorough inspection of the urethra and bladder to assess the anatomical structures and any abnormalities present. After the inspection is completed, the camera component of the cystoscope is removed, but the endoscopic sheath remains in place to facilitate the subsequent steps of the procedure.

Step 1: Insertion of the Cystourethroscope The rigid cystourethroscope is carefully inserted into the urethra and advanced into the bladder, allowing the physician to visualize the internal structures.
Step 2: Inspection of the Urethra and Bladder The physician inspects the urethra and bladder for any abnormalities or issues that may need to be addressed during the procedure.
Step 3: Deployment of the Temporary Remodeling Device After the inspection, the cystoscope is removed, and the endoscopic sheath is left in place. The temporary remodeling device is then placed through the sheath and deployed into the prostatic urethra.
Step 4: Positioning the Device The cystoscope is re-advanced into the bladder alongside the device to ensure that it is precisely positioned within the prostatic urethra. This positioning is crucial to achieve the desired outcome while avoiding the sphincter and preventing any migration of the device.
Step 5: Securing the Device Under direct vision, the physician uses a guidewire to position the temporary device with its anchoring leaflet located posterior and distal to the bladder neck. Once positioned correctly, the cystourethroscope and guidewire are removed, leaving the anchoring sutures exposed for securing to the patient.

3. Post-Procedure

Following the procedure, the temporary device remains in place for a period of five to seven days to allow for the ischemic remodeling of the bladder neck and prostate. After this duration, the device is removed in a separate procedure, which is performed under local anesthesia. This removal process is essential to ensure that the remodeling effect is achieved without causing any long-term complications. Patients may experience some discomfort during the removal, but it is generally well-tolerated. Post-procedure care may include monitoring for any signs of complications and ensuring that the patient is comfortable during the recovery period.

Short Descr	CYSTO INSJ DEV ISCHMC RMDLG
Medium Descr	CYSTO INSJ TEMP DEV ISCHMC RMDLG BLDR NECK&PRST8
Long Descr	Cystourethroscopy with insertion of temporary device for ischemic remodeling (ie, pressure necrosis) of bladder neck and prostate
Status Code	Active Code
Global Days	000 - Endoscopic or Minor Procedure
PC/TC Indicator (26, TC)	0 - Physician Service Code
Multiple Procedures (51)	3 - Special payment adjustment rules for multiple endoscopic procedures apply.
Bilateral Surgery (50)	0 - 150% payment adjustment for bilateral procedures does NOT apply.
Physician Supervisions	09 - Concept does not apply.
Assistant Surgeon (80, 82)	1 - Statutory payment restriction for assistants at surgery applies to this procedure...
Co-Surgeons (62)	0 - Co-surgeons not permitted for this procedure.
Team Surgery (66)	0 - Team surgeons not permitted for this procedure.
Endoscopic Base Code	52000 Cystourethroscopy (separate procedure)
Diagnostic Imaging Family	99 - Concept Does Not Apply
APC Status Indicator	Hospital Part B services paid through a comprehensive APC
ASC Payment Indicator	Device-intensive procedure added to ASC list in CY 2008 or later; paid at adjusted rate.
Type of Service (TOS)	2 - Surgery
Berenson-Eggers TOS (BETOS)	none
MUE	Not applicable/unspecified.