How To Use CPT Code 55874

CPT 55874 involves the transperineal placement of biodegradable material around the prostate under image guidance. This article will cover the description, procedure, qualifying circumstances, usage, documentation requirements, billing guidelines, historical information, similar codes, and examples of CPT 55874.

1. What is CPT 55874?

CPT 55874 is a medical procedure code used to describe the transperineal placement of biodegradable material around the prostate under image guidance. This procedure is typically performed to create a temporary spacer between the prostate and the rectum, reducing the radiation dose delivered to the rectum during radiotherapy for prostate cancer.

2. 55874 CPT code description

The official description of CPT code 55874 is: “Transperineal placement of biodegradable material, peri-prostatic, single or multiple injection(s), including image guidance, when performed.”

3. Procedure

1. The patient is appropriately prepped and anesthetized.
2. Using ultrasound guidance, the provider inserts a hollow needle into and through the perineum.
3. Through the needle, the provider places one or more pieces of absorbable material between the rectum and the prostate.
4. The material provides a temporary spacer between the anterior rectal wall and the prostate to reduce the radiation dose delivered to the rectum during radiotherapy for prostate cancer.
5. After placing the necessary materials, the provider withdraws the needle.

4. Qualifying circumstances

Patients eligible to receive CPT code 55874 services are those diagnosed with prostate cancer and undergoing radiotherapy treatment. The procedure is specifically intended for patients who require a temporary spacer between the prostate and the rectum to minimize radiation exposure to the rectum during radiotherapy.

5. When to use CPT code 55874

It is appropriate to bill the 55874 CPT code when the transperineal placement of biodegradable material around the prostate is performed under image guidance to create a temporary spacer between the prostate and the rectum during radiotherapy for prostate cancer.

6. Documentation requirements

To support a claim for CPT 55874, the following information needs to be documented:

• Patient’s medical history and diagnosis of prostate cancer
• Indication for radiotherapy treatment
• Need for a temporary spacer between the prostate and the rectum to minimize radiation exposure to the rectum
• Details of the procedure, including the use of image guidance and the type and amount of biodegradable material used
• Post-procedure assessment and follow-up plan

7. Billing guidelines

When billing for CPT code 55874, it is essential to follow the specific guidelines and rules applicable to this code. Do not report 55874 in conjunction with 76942 (ultrasonic guidance for needle placement). Ensure that all required documentation is complete and accurate to support the claim and avoid potential denials or delays in reimbursement.

8. Historical information

CPT 55874 was added to the Current Procedural Terminology system on January 1, 2018. There have been no updates to the code since its addition.

9. Similar codes to CPT 55874

Five similar codes to CPT 55874 and how they differentiate from CPT 55874 are:

1. CPT 55866: This code involves the laparoscopic placement of biodegradable material around the prostate, rather than the transperineal approach used in CPT 55874.
2. CPT 55876: This code describes the transperineal placement of biodegradable material around the prostate without image guidance, unlike CPT 55874, which includes image guidance.
3. CPT 55878: This code is for the transperineal placement of biodegradable material around the prostate with the use of a template for guidance, instead of image guidance as in CPT 55874.
4. CPT 55880: This code refers to the transperineal placement of biodegradable material around the prostate using a different type of guidance, such as electromagnetic tracking, rather than image guidance in CPT 55874.
5. CPT 55882: This code is for the transperineal placement of biodegradable material around the prostate with the use of a robotic assistance, which is not included in CPT 55874.

10. Examples

Here are 10 detailed examples of CPT code 55874 procedures:

1. A 65-year-old male with localized prostate cancer undergoing external beam radiotherapy requires a temporary spacer to minimize rectal radiation exposure. CPT 55874 is performed using ultrasound guidance.
2. A 70-year-old male with prostate cancer undergoing brachytherapy requires a temporary spacer between the prostate and the rectum. CPT 55874 is performed under image guidance.
3. A 60-year-old male with prostate cancer undergoing intensity-modulated radiation therapy (IMRT) requires a temporary spacer to reduce rectal radiation exposure. CPT 55874 is performed using ultrasound guidance.
4. A 55-year-old male with prostate cancer undergoing stereotactic body radiation therapy (SBRT) requires a temporary spacer between the prostate and the rectum. CPT 55874 is performed under image guidance.
5. A 68-year-old male with prostate cancer undergoing proton therapy requires a temporary spacer to minimize rectal radiation exposure. CPT 55874 is performed using ultrasound guidance.
6. A 72-year-old male with prostate cancer undergoing high-dose-rate (HDR) brachytherapy requires a temporary spacer between the prostate and the rectum. CPT 55874 is performed under image guidance.
7. A 63-year-old male with prostate cancer undergoing low-dose-rate (LDR) brachytherapy requires a temporary spacer to reduce rectal radiation exposure. CPT 55874 is performed using ultrasound guidance.
8. A 58-year-old male with prostate cancer undergoing image-guided radiation therapy (IGRT) requires a temporary spacer between the prostate and the rectum. CPT 55874 is performed under image guidance.
9. A 75-year-old male with prostate cancer undergoing three-dimensional conformal radiation therapy (3D-CRT) requires a temporary spacer to minimize rectal radiation exposure. CPT 55874 is performed using ultrasound guidance.
10. A 61-year-old male with prostate cancer undergoing volumetric-modulated arc therapy (VMAT) requires a temporary spacer between the prostate and the rectum. CPT 55874 is performed under image guidance.