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The CPT® Code 55865 refers to a surgical procedure that involves the exposure of the prostate gland through any approach for the purpose of inserting a radioactive substance, typically used in brachytherapy. This procedure is performed in conjunction with a bilateral pelvic lymphadenectomy, which entails the removal of lymph nodes from both sides of the pelvis, specifically targeting the external iliac, hypogastric, and obturator nodes. The surgical approach may include either a retropubic incision, which is made in the lower abdomen, or a perineal incision. In the case of a retropubic approach, the bladder is carefully displaced to access the area behind the pubic bone, allowing the surgeon to reach the prostate. During the procedure, the physician may utilize a finger guide placed in the rectum to accurately position a hollow applicator needle into the prostate tissue. Once the needle is correctly positioned, radioactive seeds are introduced through the needle and implanted into the prostate. This process involves withdrawing the needle and repositioning it in small increments to place additional seeds, ensuring comprehensive coverage of the target area. The inclusion of a bilateral pelvic lymphadenectomy in this procedure signifies a more extensive surgical intervention, as it involves the removal of all lymph nodes along the obturator fossa, external iliac vein, and hypogastric artery, which is a critical aspect of managing potential cancer spread in the pelvic region.
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The procedure described by CPT® Code 55865 is indicated for patients who require brachytherapy for prostate cancer treatment. The specific indications for this procedure include:
The procedure involves several critical steps to ensure successful exposure of the prostate and insertion of radioactive substances. The steps are as follows:
Post-procedure care following the implementation of CPT® Code 55865 typically involves monitoring the patient for any immediate complications related to the surgery. Patients may experience discomfort or pain at the surgical site, which can be managed with appropriate analgesics. Additionally, the patient will be monitored for any signs of infection or complications related to the lymphadenectomy. Follow-up appointments are essential to assess the effectiveness of the brachytherapy and to monitor for any potential recurrence of cancer. Patients may also require imaging studies or laboratory tests to evaluate the prostate and lymph nodes post-procedure. It is important for patients to adhere to any specific post-operative instructions provided by their healthcare team to ensure optimal recovery.
| Short Descr | EXTENSIVE PROSTATE SURGERY | Medium Descr | EXPOS PROSTATE INSJ RADIOAC SBST W/BI PELV LYMPH | Long Descr | Exposure of prostate, any approach, for insertion of radioactive substance; with bilateral pelvic lymphadenectomy, including external iliac, hypogastric and obturator nodes | Status Code | Active Code | Global Days | 090 - Major Surgery | PC/TC Indicator (26, TC) | 0 - Physician Service Code | Multiple Procedures (51) | 2 - Standard payment adjustment rules for multiple procedures apply. | Bilateral Surgery (50) | 2 - 150% payment adjustment does NOT apply. | Physician Supervisions | 09 - Concept does not apply. | Assistant Surgeon (80, 82) | 2 - Payment restriction for assistants at surgery does not apply to this procedure... | Co-Surgeons (62) | 1 - Co-surgeons could be paid, though supporting documentation is required... | Team Surgery (66) | 0 - Team surgeons not permitted for this procedure. | Diagnostic Imaging Family | 99 - Concept Does Not Apply | APC Status Indicator | Inpatient Procedures, not paid under OPPS | Type of Service (TOS) | 2 - Surgery | Berenson-Eggers TOS (BETOS) | P1G - Major procedure - Other | MUE | 1 | CCS Clinical Classification | 118 - Other OR therapeutic procedures, male genital |
| 51 | Multiple procedures: when multiple procedures, other than e/m services, physical medicine and rehabilitation services or provision of supplies (eg, vaccines), are performed at the same session by the same individual, the primary procedure or service may be reported as listed. the additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s). note: this modifier should not be appended to designated "add-on" codes (see appendix d). | 59 | Distinct procedural service: under certain circumstances, it may be necessary to indicate that a procedure or service was distinct or independent from other non-e/m services performed on the same day. modifier 59 is used to identify procedures/services, other than e/m services, that are not normally reported together, but are appropriate under the circumstances. documentation must support a different session, different procedure or surgery, different site or organ system, separate incision/excision, separate lesion, or separate injury (or area of injury in extensive injuries) not ordinarily encountered or performed on the same day by the same individual. however, when another already established modifier is appropriate it should be used rather than modifier 59. only if no more descriptive modifier is available, and the use of modifier 59 best explains the circumstances, should modifier 59 be used. note: modifier 59 should not be appended to an e/m service. to report a separate and distinct e/m service with a non-e/m service performed on the same date, see modifier 25. | 82 | Assistant surgeon (when qualified resident surgeon not available): the unavailability of a qualified resident surgeon is a prerequisite for use of modifier 82 appended to the usual procedure code number(s). |
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| Pre-1990 | Added | Code added. |
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