How To Use CPT Code 55860

CPT 55860 describes the exposure of the prostate, using any approach, for the insertion of a radioactive substance. This article will cover the description, official details, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 55860?

CPT 55860 can be used to describe the surgical exposure of the prostate to enable the insertion of a radioactive substance. This procedure is typically performed by a provider to treat malignant cancer of the prostate. It involves making an incision in the perineum, inserting a tubular sheath in the rectum, and a catheter into the urethra to drain the bladder. The provider explores and uproots the bladder to reach the prostate gland, places a needle at the tumor site, and another provider advances radioactive seeds into the prostate using ultrasound guidance. After seed insertion, a drainage tube is inserted, the area is irrigated, bleeding is checked, instruments are removed, and the incision is closed.

2. Official Description

The official description of CPT code 55860 is: ‘Exposure of prostate, any approach, for insertion of radioactive substance.’

3. Procedure

1. The provider makes an incision in the perineum to expose the prostate.
2. A tubular sheath is inserted in the rectum to facilitate instrument insertion.
3. A catheter is placed in the urethra to drain the bladder.
4. The provider explores and uproots the bladder to reach the prostate gland.
5. A needle is placed at the site of the tumor.
6. Another provider advances radioactive seeds into the prostate using ultrasound guidance.
7. A drainage tube is inserted in the wound.
8. The area is irrigated, bleeding is checked, instruments are removed, and the incision is closed.

4. Qualifying circumstances

CPT 55860 is performed on patients with malignant cancer of the prostate. The procedure involves the exposure of the prostate to enable the insertion of a radioactive substance for treatment. It may be performed by the same provider or different providers, such as a urologist and an oncologist. Ultrasound or other imaging guidance may be used during the procedure.

5. When to use CPT code 55860

CPT code 55860 should be used when the provider performs the exposure of the prostate for the insertion of a radioactive substance to treat malignant cancer of the prostate. It should not be reported if the procedure does not involve the insertion of a radioactive substance.

6. Documentation requirements

To support a claim for CPT 55860, the provider must document the following information:

• Diagnosis of malignant cancer of the prostate
• Details of the procedure, including the approach used for exposure
• Insertion of the radioactive substance
• Use of ultrasound or other imaging guidance, if applicable
• Any complications or additional procedures performed
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT 55860, ensure that the procedure involves the exposure of the prostate for the insertion of a radioactive substance. Report ultrasound or other imaging guidance separately, if used. Select clinical brachytherapy radiation treatment codes from the range 77750–77799 for the insertion of radioactive seeds. It is important to note that CPT 55860 should not be reported if it is performed without the insertion of a radioactive substance.

8. Historical information

CPT 55860 was added to the Current Procedural Terminology system on January 1, 1990. There have been no updates or changes to the code since its addition.

9. Examples

1. A urologist performs the exposure of the prostate and inserts radioactive seeds to treat malignant cancer of the prostate.
2. A patient with prostate cancer undergoes the exposure of the prostate and the insertion of a radioactive substance by an oncologist.
3. A provider uses ultrasound guidance during the exposure of the prostate and the insertion of a radioactive substance for the treatment of prostate cancer.
4. A urologist performs the exposure of the prostate and inserts radioactive seeds using a perineal approach.
5. An oncologist inserts a radioactive substance into the prostate following the exposure performed by a different provider.
6. A patient with prostate cancer undergoes the exposure of the prostate and the insertion of a radioactive substance as part of their treatment plan.
7. A provider performs the exposure of the prostate and inserts radioactive seeds using a retropubic radical approach.
8. An oncologist uses ultrasound guidance during the exposure of the prostate and the insertion of a radioactive substance for the treatment of prostate cancer.
9. A urologist performs the exposure of the prostate and inserts a radioactive substance to treat a patient with malignant cancer of the prostate.
10. A provider performs the exposure of the prostate and inserts radioactive seeds using a subtotal approach.