Urology Coding Alert

Question: Under what circumstances can I use the new code for prostate freezing as a cancer treatment?

North Carolina Subscriber

Answer: Medicare will allow 55873 (cryosurgical ablation of the prostate [includes ultrasonic guidance for interstitial cryosurgical probe placement]) only as a primary treatment for localized prostate cancer. This means it must be the first treatment attempted. Most urologists are using this as a secondary line of treatment if another type of treatment has failed. According to Medicare, there is insufficient evidence to demonstrate its efficacy as salvage therapy.

Code 55873, new for 2001, replaces G0160, the HCPCS code Medicare required for cryosurgery of the prostate. As of May 1, 2000, Medicare reimbursed G0160 with G0161 (ultrasonic guidance for interstitial placement of cyosurgical probes) for the ultrasonic guidance. Now, both codes the surgery and the probe have been incorporated into 55873.