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MP 7.01.49 Laser Prostatectomy

 

Medical Policy    
Section
Surgery
Original Policy Date
7/31/96
Last Review Status/Date
Reviewed with literature search/1:2005
Issue
2:2005
  Return to Medical Policy Index

Disclaimer

Our medical policies are designed for informational purposes only and are not an authorization, or an explanation of benefits, or a contract.  Receipt of benefits is subject to satisfaction of all terms and conditions of the coverage.  Medical technology is constantly changing, and we reserve the right to review and update our policies periodically.

 


 

Description

Laser prostatectomy, using a variety of lasers, has been investigated as a less invasive alternative to transurethral resection of the prostate (TURP). A variety of lasers have been used in a variety of ways to vaporize or coagulate prostate tissue. For example, Nd:YAG lasers have been used in either a contact or non-contact mode to treat prostatic tissue at its surface. In the contact mode, the Nd:YAG laser directly ablates prostatic tissue, producing an effect similar to a slowly progressive TURP. In the non-contact (side-firing) mode, the laser uses refraction to coagulate tissue and or/vaporize the urethral margin. More recently holmium (Ho):YAG lasers and high power KTP lasers have been investigated. These 2 non-contact lasers have different absorption properties. The Ho:YAG laser is maximally absorbed at a wavelength of 2000 nm and is selectively absorbed by water. In contrast, the KTP laser (also referred to as a green light laser or photoselective vaporization) is maximally absorbed at a wavelength of 600 nm and is selectively absorbed by oxyhemoglobin. Advocates of the green light laser propose that its absorption by oxyhemoglobin is an advantage since the laser energy is not dissipated in an aqueous environment, and is selectively absorbed by vascular tissue.

Interstitial laser prostatectomy using either Nd:YAG or diode lasers has also been investigated as a technique to achieve coagulation necrosis inside the adenoma. In this procedure the laser (either an ND:YAG laser or a diode laser) is inserted into the prostate and activated. After treatment the coagulated tissue is gradually reabsorbed with subsequent shrinkage of the treated areas. An interstitial laser procedure is similar in concept to transurethral needle ablation (TUNA, see policy No. 7.01.59), which is also intended to induce interstitial coagulation necrosis, although it uses a different energy source.

 


 

Policy

Laser prostatectomy, using either contact, non-contact, or interstitial techniques, may be considered medically necessary for patients with benign prostatic hypertrophy who are candidates for transurethral resection of the prostate (TURP).

 


 

Policy Guidelines

While CPT codes 52647 and 52648 describe non-contact and contact laser coagulation of prostate, respectively, no specific CPT code describes interstitial laser coagulation. CPT code 52647 may be used, as this code essentially describes coagulation necrosis of the prostate using a laser.

 


 

Benefit Application

BlueCard/National Account Issues

Laser prostatectomy using a diode laser (i.e., interstitial laser coagulation) or a KTP laser may be performed in the office setting.

 


 

Rationale

This policy is based on a 1996 TEC Assessment (1), which was updated in 2005 with further information on different types of lasers used for laser prostatectomy, specifically the diode laser used for interstitial laser coagulation necrosis and the KTP laser (2-6). However, the policy statement regarding laser prostatectomy, which does not distinguish among the various lasers that may be used, is unchanged. A literature search did not identify any clinical trials that directly compared the outcomes using different lasers; therefore, there are inadequate data to determine the equivalence or superiority of different approaches. A recent review suggests that Ho:YAG lasers and high-power KTP lasers (i.e., green light lasers) are most commonly used, while there is declining enthusiasm for interstitial or contact laser coagulation. (7)

References:

  1. 1996 TEC Assessment
  2. Martenson AC, de la Rosette JJ. Interstitial laser coagulation in the treatment of benign prostatic hyperplasia using a diode laser system: results of an evolving technology. Prostate Cancer Prostatic Dis 1999; 2(3):148-54.
  3. Floratos DL, Sonke GS, Francisca EA et al. Long-term follow-up of laser treatment of lower urinary tract symptoms suggestive of bladder outlet obstruction. Urology 2000; 56(4):604-9.
  4. Virdi JS, Chandrasekar P, Kapasi F. Interstitial laser ablation (Indigo) of the prostate – a randomised prospective study, three-year follow-up (abstract). J Urol 2001; 165(suppl):368.
  5. Te AE, Malloy TR, Stein BS et al. Photoselective vaporization of the prostate for the treatment of benign prostatic hyperplasia: 12 month results from the first United States multicenter prospective trial. J Urol 2004; 172(4 pt 1):1404-8.
  6. Sandhu JS, Ng C, Vanderbrink BA et al. High-power potassium-titanyl-phosphate photoselective laser vaporization of prostate for treatment of benign prostatic hyperplasia in men with large prostates. Urology 2004; 64(6):1155-9.
  7. Tan AH, Gilling PJ. Lasers in the treatment of benign prostatic hyperplasia: an update. Curr Opin Urol 2005; 15(1):55-8.

 

Codes

Number

Description

CPT 

52647 

Non-contact laser coagulation of prostate (code descriptor revised 1/1/06 - Laser coagulation of prostate, including control of postoperative bleeding, complete (vasectomy, meatotomy, cystourethroscopy, urethral calibration and/or dilation, and internal urethrotomy are included if performed) 

 

52648 

Contact laser vaporization of prostate (code descriptor revised 1/1/06 – Laser vaporization of prostate, including control of postoperative bleeding, complete (vasectomy, meatotomy, cystourethroscopy, urethral calibration and/or dilation, internal urethrotomy and transurethral resection of prostate are included if performed) 

ICD-9 Procedure 

60.21 

Transurethral laser-induced prostatectomy 

ICD-9 Diagnosis 

600 

Benign prostatic hypertrophy (BPH) code range 

HCPCS 

No Code 

 

Type of Service 

Surgery 

Place of Service 

Inpatient/Outpatient 

 


 

Index

Green Light Laser, Laser Prostatectomy
GreenLight PVP
Interstitial Laser Prostatectomy
Laser Prostatectomy
Photoselective Laser Vaporization, Laser Prostatectomy
Prostatectomy, Laser

 


 

Policy History

Date Action Reason
07/31/96 Add to Surgery section New policy
04/15/02 Replace policy Policy reviewed without literature review; new review date only
10/08/02 Replace policy Policy revised to provide discussion of different laser types; no change in policy statement
12/17/03 Replace policy Policy reviewed by consensus without literature review; no changes in policy; no further review scheduled
04/1/05 Replace policy Policy updated with discussion of high power KTP lasers; no change in policy statement; no further review scheduled
12/14/05 Replace policy – coding update only CPT coding updated