by Dee Mandley, RHIT, CCS, CCS-P, CDIP
These codes were created to report the iTind™ procedure. The iTind™ device consists of a series of tines that slowly expand within the prostatic urethra compressing prostatic tissue restricting blood flow. The restriction of blood flow causes pressure necrosis within the prostate and ultimately remodels/reduces the size of the prostate. This temporary device is guided through the urethra to the prostate via cystourethroscopy and then removed 5 to 7 days later via a urethral catheter. Review the graphic below to see the steps and results of the iTind™.
Assign 53865 for the insertion and 53866 for the removal via catheter. If a cystourethroscopy is used to remove the device report 52310 Cystourethroscopy, with removal of foreign body, calculus, or ureteral stent from urethra or bladder; simple.
These codes were created to report Transurethral Ultrasound Ablation (TULSA) procedure performed with the TULSA-PRO® system.
The TULSA procedure takes place with the patient in an MRI machine. An ultrasound applicator with 10 transducer elements is inserted into the urethra. Utilizing MRI imaging during the procedure allows the surgeon to view the prostate in axial, sagittal, and coronal planes. Exact boundary lines can then be drawn around the prostate section corresponding to each of the 10 elements. The surgeon can control and activate each transducer element to specific targeted areas within the prostate. The ultrasound applicator also cools the urethra during ablation protecting the urethra from the thermal ultrasound energy. This procedure also includes the insertion of a passive cooling device into the rectum to protect the tissue there. The ultrasound applicator conducts a sweeping pattern of directional ablation while rotating within the urethra ablating only the prescribed boundary lines. This is known as an inside-out approach because ablation occurs from inside the urethra heating outwards to the edge of the prostate. The inside-out approach preserves neurovascular bundles and minimizes surrounding tissue damage.
In conclusion, both the iTind™ and TULSA procedures offer innovative approaches to treating benign prostatic hyperplasia (BPH) and prostate cancer with distinct mechanisms and technologies. Both of these ground-breaking procedures are typically done in an outpatient encounter and represent significant advancements offering patients options that are tailored to their specific needs and conditions.
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