Prostate Volume Study & Brachytherapy: CPT Codes and Guideline
Prostate Volume Study
A volume study is an ultrasound study of the prostate designed to help determine whether seed implantation is technically appropriate and is also used to plan the implant. It is a simple procedure which requires placing the ultrasound probe into the rectum and taking a series of pictures.
The normal prostate size for an adult male is 15cc to 30cc (one half ounce to one ounce). Men whose prostate gland is larger than 30 cc are more likely to be diagnosed with either benign hyperplasia (enlargement) or prostate cancer than those whose prostate is in the normal range.
Prostate cancer is the model cancer for brachytherapy. Permanent seed implants involve injecting approximately 100 radioactive seeds into the prostate gland. They give off their radiation at a low dose rate over several weeks or months, and then the seeds remain in the prostate gland permanently.
Brachytherapy involves placing a radioactive material directly inside or next to the tumor. Brachytherapy, also called internal radiation therapy, allows a physician to use a higher total dose of radiation to treat a smaller area and in a shorter time than is possible with external beam radiation treatment.
High-dose rate brachytherapy lasts about 30 minutes. Your doctor inserts the radioactive material into the prostate. The doctor may use a computerized robot to do this. The radioactive material is removed right away after treatment.
Brachytherapy seedsThere are two types of brachytherapy – high dose-rate (HDR) and low dose-rate (LDR). LDR brachytherapy is the type that is most commonly used to treat prostate cancer; it may sometimes be referred to as ‘seed implantation’ or it may also be called ‘pinhole surgery’.
The radioactivity of the seeds decays very quickly with time. The radiation used for the treatment of prostate cancer is delivered during the first half-life of the isotope, which is 60 days for Iodine-125.
CPT Codes for Prostate Volume Study & Brachytherapy and guideline
A volume study is an ultrasound study of prostate. We use these ultrasound pictures to determine the exact size and shape of prostate gland and to create a 3-D image of the prostate. The 3-D image is used to develop individualized treatment plan.
76873 – (echography, transrectal; prostate volume study for brachytherapy treatment planning [separate procedure]).
76965 – (ultrasonic guidance for interstitial radioelement application)
For brachytherapy, the scan is used to determine the size of the gland and customize a seed-implant treatment. Each generated image is used to calculate the prostate volume, the number of radiation seeds and the exact placement of each seed. Use CPT code 76873.
CPT Code 76965 is reported at the time of the seed implantation by the urologist or the brachytherapist, depending on who performs the procedure.
When the urologist performs an ultrasound for prostate volume study (to determine prostate size and plan for needle placement of seeds) before the surgery,code this service with CPT code 76873, Ultrasound, transrectal; prostate volume study for brachytherapy treatment planning (separate procedure).
Brachytherapy is an advanced cancer treatment. Radioactive seeds or sources are placed in or near the tumor itself, giving a high radiation dose to the tumor while reducing the radiation exposure in the surrounding healthy tissues. The term “brachy” is Greek for short distance.
Following CPT codes are used for brachytherapy treatment of prostate:-
Transperineal placement of needles or catheters into prostate for interstitial radioelement application, with or without cystoscopy
Ultrasonic guidance for interstitial radioelement application
The performance of a transrectal ultrasound prior to a 53852Transurethral needle ablation (TUNA) is not considered a “prostate volume study.” A true prostate volume study includes 5 mm cuts and views. To code for a TRUS prior to TUNA, use CPT code76872 Ultrasound, transrectal.
When the urologist performs an ultrasound for prostate volume studybefore the surgery, code this service with CPT code 76873,Ultrasound, transrectal; prostate volume study for brachytherapy treatment planning (separate procedure).
For Gold seed markersbill both CPT 55876Placement of interstitial device(s) for radiation therapy guidance (eg, fiducial markers, dosimeter) prostate (via needle, any approach) single or multiple, and HCPCS code A4648Tissue marker, implantable, any type, each.
Payment for Implantable Tissue Markers (HCPCS Code A4648)