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Tip: Understand the 2009 prostate procedure changes

Ambulatory Surgery Reimbursement Update, December 16, 2008

Medicare has deleted five prostate procedure codes from the ASC list of covered procedures effective January 1, 2009, because the AMA deleted them from the 2009 CPT Manual. The five codes are as follows:

• Code 52606—Transurethral fulguration for postoperative bleeding occurring after the usual follow-up time

• Code 52612—Transurethral resection of prostate; first stage of two-stage resection (partial resection)

• Code 52614—Transurethral resection of prostate; second stage of two-stage resection (resection completed)

• Code 52620—Transurethral resection; of residual obstructive tissue after 90 days postoperative

• Code 53853—Transurethral destruction of prostate tissue; by water-induced thermotherapy

The AMA added one new prostate code for 2009, which Medicare has also added to their list of covered procedures. CPT code 55706 is the code for prostate biopsies performed with a needle by a transperineal approach with stereotactic template guided saturation sampling, which includes imaging guidance. Medicare’s reimbursement for this new code is $466.09 nationally.

This tip is brought to you by Ellis Medical Consulting, Inc.

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