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MP 7.01.59 Transurethral Radiofrequency Needle Ablation of the Prostate

Medical Policy
Section
Surgery
Original Policy Date
1/30/98
Last Review Status/Date
Reviewed with literature search/3:1999
Issue
2:2003
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

Transurethral radiofrequency needle ablation of the prostate (also known as TUNA or RFNA) of the prostate has been proposed as an alternative to transurethral resection of the prostate (TURP) for treatment of benign prostatic hyperplasia (BPH). Other alternatives include transurethral incision of the prostate, intraurethral stents, balloon dilation, heat therapy (e.g., microwave hyperthermia), high-intensity focused ultrasound (HIFU), roller ball transurethral vaporization of the prostate, and laser prostatectomy. The mechanism of TUNA is thermal coagulation necrosis. The TUNA procedure is performed under direct vision. The intraurethral components are contained in a sheath, including 2 flexible needles that are deployed into the lateral lobes of the prostate adenoma to a depth determined by transrectal ultrasound measurement. Each lobe is treated 2 to 4 times, and the procedure averages 30 minutes in length.


Policy

Transurethral radiofrequency needle ablation of the prostate (TUNA) may be considered medically necessary as a treatment of benign prostatic hypertrophy.


Policy Guidelines

In 1998, a new CPT code was introduced (53852), which specifically describes transurethral radiofrequency needle ablation of the prostate.


Benefit Application

No applicable information


Rationale

This policy is based on a 1998 TEC Assessment (1), which offered the following conclusions:

  • Clinical series that includes a total of 910 patients consistently reports decreases in symptoms and demonstrates improvement in urodynamic measures such as peak maximal flow and post-voiding residual 3–6 months after radiofrequency needle ablation (RFNA).
  • A randomized clinical trial has also been published, comparing RFNA with TURP. The results from the clinical trial report significant symptomatic and urodynamic improvement with both treatments showing improvement. Although TURP produced greater improvement in symptoms and urologic functions, the average American Urological Association symptoms score for patients who underwent RFNA improved from severe to the moderate range of BPH symptoms severity. Adverse events associated with RFNA were transient and significantly less than for TURP. In addition, RFNA did not produce the harmful outcomes related to blood transfusion and post-TURP syndrome.

References:

  1. 1998 TEC Assessment, Tab 25

 

Codes

Number

Description

CPT  53852  Transurethral destruction of prostate tissue; by radiofrequency thermotherapy 
ICD-9 Procedure  60.29  Other transurethral prostatectomy 
ICD-9 Diagnosis  600.00–600.01  Benign prostatic hypertrophy code range 
HCPCS  No Code   
Type of Service  Urology 
Place of Service  Inpatient
 
Outpatient
 


Index

Ablation, Prostate
Benign Prostatic Hyperplasia
Needle Ablation, Prostate
Prostate, Needle Ablation
Radiofrequency Needle Ablation
RFNA
TUNA


Policy History

Date Action Reason
01/30/98 Add to Surgery section New policy
03/15/99 Replace policy Policy revised and changed; referenced TEC assessment
05/17/02 Replace policy Archived policy
07/12/02 Replace policy Policy released in May 2002 was incorrect version. Policy version corrected. No literature review. Issue date changed
07/17/03 Replace policy Policy no longer scheduled for review
09/27/05 Replace policy ICD-9 diagnosis codes added to code table


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