How To Use CPT Code 55862

CPT 55862 describes the surgical exposure of the prostate, which involves the insertion of radioactive material and lymph node biopsy(s). This article will cover the description, official description, procedure, qualifying circumstances, appropriate usage, documentation requirements, billing guidelines, historical information and billing examples.

1. What is CPT Code 55862?

CPT 55862 is used to describe the surgical exposure of the prostate, which allows for the insertion of radioactive material to treat malignant cancer of the prostate. During this procedure, the provider makes an incision in the perineum and explores the area to reach the prostate gland. Nearby lymph nodes are also sampled for analysis. The provider may work in collaboration with another provider who inserts the radioactive seeds into the prostate using ultrasound guidance.

2. Official Description

The official description of CPT code 55862 is: ‘Exposure of prostate, any approach, for insertion of radioactive substance; with lymph node biopsy(s) (limited pelvic lymphadenectomy)’

3. Procedure

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

4. Qualifying circumstances

CPT 55862 is performed on patients with malignant cancer of the prostate. The procedure involves the insertion of radioactive material and lymph node biopsy(s). It is important to note that the insertion of radioactive material may be performed by the same provider or a different provider, such as a urologist and an oncologist working together. Ultrasound or other imaging guidance may also be used and should be reported separately.

5. When to use CPT code 55862

CPT code 55862 should be used when the provider performs the surgical exposure of the prostate, inserts radioactive material, and performs lymph node biopsy(s). It is important to report this code when all the components of the procedure are performed. If only a portion of the procedure is performed, a different code may be more appropriate.

6. Documentation requirements

To support a claim for CPT 55862, the provider must document the following information:

• Indication for the procedure, such as the presence of malignant cancer of the prostate
• Details of the surgical exposure, including the approach used
• Documentation of the insertion of radioactive material
• Documentation of lymph node biopsy(s) performed
• Any additional procedures or services provided during the same encounter
• Signature of the provider performing the procedure

7. Billing guidelines

When billing for CPT 55862, ensure that the procedure is performed as described in the official description. It is important to report any additional procedures or services separately. Select clinical brachytherapy radiation treatment codes from the range 77750–77799 for reporting the insertion of radioactive material. Ultrasound or other imaging guidance should also be reported separately.

8. Historical information

CPT 55862 was added to the Current Procedural Terminology system on January 1, 1990. In 2017, it was added to the Inpatient Only (IPO) list for Medicare.

9. Examples

1. A urologist performs the surgical exposure of the prostate, inserts radioactive material, and performs lymph node biopsy(s) for a patient with malignant cancer of the prostate.
2. An oncologist inserts radioactive seeds into the prostate using ultrasound guidance after a urologist performs the surgical exposure and lymph node biopsy(s).
3. A patient with malignant cancer of the prostate undergoes the surgical exposure of the prostate, insertion of radioactive material, and lymph node biopsy(s) as part of their treatment plan.
4. A provider performs the surgical exposure of the prostate and lymph node biopsy(s) while another provider inserts the radioactive material for a patient with malignant cancer of the prostate.
5. During a surgical procedure, a provider performs the exposure of the prostate, insertion of radioactive material, and lymph node biopsy(s) to treat malignant cancer of the prostate.
6. A patient with malignant cancer of the prostate undergoes the surgical exposure of the prostate, insertion of radioactive material, and lymph node biopsy(s) as part of their comprehensive treatment.
7. A urologist performs the surgical exposure of the prostate, insertion of radioactive material, and lymph node biopsy(s) for a patient with advanced malignant cancer of the prostate.
8. An oncologist inserts radioactive seeds into the prostate using ultrasound guidance after a urologist performs the surgical exposure and lymph node biopsy(s) for a patient with localized malignant cancer of the prostate.
9. A patient with malignant cancer of the prostate undergoes the surgical exposure of the prostate, insertion of radioactive material, and lymph node biopsy(s) to target and treat the cancerous tumor.
10. A provider performs the surgical exposure of the prostate and lymph node biopsy(s) while another provider inserts the radioactive material for a patient with aggressive malignant cancer of the prostate.