Medical, Uncategorized

Rezum Procedure: Introduction and Coding Guideline

Rezum is a transurethral RF thermal therapy to treat benign prostatic hyperplasia (BPH) that can be performed in a clinic or out-patient setting. Using a hand-held device, Rezum delivers radio frequency generated thermal therapy, in the form of water vapor, directly to the extra prostate tissue that is causing symptoms such as frequency, urgency, irregular flow, weak stream, straining and getting up at night to urinate.Image result for rezum procedure

The Rezum therapy is completed in a single visit; there is no need for ongoing therapy.

It works by delivering very small amounts of steam to the enlarged prostate.  This process damages the cells causing obstruction, thus reducing the overall size of the prostate and the symptoms associated with BPH such as:

  • A weak urine stream
  • Trouble starting the flow of urine
  • Starting and stopping again when urinating
  • Not emptying your bladder completely
  • Urinating more often, especially at night
  • Sudden urges to urinate
  • Leaking or dribbling after you urinate
  • Straining to urinate

Supporting ICD – 10

Benign prostatic hyperplasia without lower urinary tract symptoms

  • N40.0 is a billable/specific ICD-10-CM code that can be used to indicate a diagnosis for reimbursement purposes.
  • ICD-10-CM N40.0 was revised in the set of 2017 ICD-10-CM changes, effective October 1, 2016. The old description was: Enlarged prostate without lower urinary tract symptoms.
  • This is the American ICD-10-CM version of N40.0. Other international versions of ICD-10 N40.0 may differ.
  • Reimbursement claims with a date of service on or after October 1, 2015 require the use of ICD-10-CM codes.

Applicable To

  • Enlarged prostate without LUTS
  • Enlarged prostate NOS

Synonyms

  • Benign localized hyperplasia of prostate
  • Benign localized prostatic hyperplasia (BPH)
  • Benign prostatic hyperplasia
  • Benign prostatic hyperplasia (BPH)
  • BPH (benign prostatic hypertrophy)
  • Enlarged prostate
  • Hyperplasia of prostate
  • Hyperplasia of prostate without urinary obstruction
  • Large prostate
  • Prostate hyperplasia

ICD-10-CM Coding Rules

  • N40.0 is applicable to adult patients aged 15 – 124 years inclusive.
  • N40.0 is applicable to male patients.

Supporting CPT Code

Coding for the radiofrequency thermotherapy ablation procedure to treat BPH using the Rezūm system through the American Urological Association Coding & Reimbursement Committee. Based on their thorough review confirmed that the procedure is appropriately reported with CPT 53852, transurethral destruction of prostate tissue; by radiofrequency thermotherapy.

NOTE: 

Medicare Administrative Contractors (MACs) consider radiofrequency thermotherapy ablation reported using CPT code 53852 medically necessary for treating patients with BPH. However, there are a few MACs that have developed specific Local Coverage Decisions (LCD) that may require reporting with code 53899 Unlisted procedure, urinary system and to insert “Rezūm Transurethral destruction of prostate tissue; by radiofrequency thermotherapy” in box 19 of the claim form to assure prompt payment. In the absence of a LCD, report 53852.

In private insurance, Most payers consider CPT code 53852 medically necessary for patients with benign prostatic hypertrophy (BPH).

Pre – Authorization are not compulsory depend on the situation.

The Rezūm System is a technology used to perform the transurethral RF thermotherapy procedures to treat BPH and reported using CPT code 53852. For the majority of payers, this well-established procedure code is not on their prior authorization list.  If a patient’s payer requires prior authorization, this should occur prior to the procedure being provided.

Conscious sedation is used during an office based, RF thermotherapy BPH ablation procedure, an independent, trained observer is required to be present to monitor the patient’s status. When these services are provided by the surgeon they may be reported using CPT codes 99144-99145. The intra-service time begins with the administration of the agent and concludes at the end of personal contact with the patient by the physician providing the sedation. Billing of these services requires continuous face-to-face attendance.

CPT code 53852 includes administration of a prostate block and transrectal ultrasound, if performed. These services should not be reported separately as they are considered bundled and included in the payment for the surgical procedure.

 

 

 

 

 

 

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