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    How to get reimbursed for BPH water vapor ablation

    Until introduction of new code in 2019, follow one of two coding pathways for payment

    Ray Painter, MDRay Painter, MD Mark PainterMark Painter

     

    How do I code for convective water vapor ablation for lower urinary tract symptoms/BPH (Rezum System)?

    Up front, we must disclose that Physician Reimbursement Services has contracted with NxThera to provide support for offices that have billed for Rezum. In this article, we will provide the basics as we know them at this point.

    Until recently, you could find an article published by the AUA Coding and Reimbursement Committee recommending the use of CPT Code 53852 (Transurethral destruction of prostate tissue; by radiofrequency thermotherapy) online. That article was removed from the AUA website in August. A search of www.auanet.org for Rezum at the time this article was written did not return any information. However, there is an archival post on the AUA website referencing Rezum (bit.ly/Rezumclearance).  

    Also by the Painters: Practice ‘report card’ tracks performance

    The recently published public transcript from the September meeting of the CPT Editorial Panel was released officially on Oct. 13, 2017 and can be found at bit.ly/CPTpanelsummary. Item 21 on this report indicates that the panel decided to “add a code 538X3 to report water vapor or steam thermotherapy for destruction of prostate tissue.” Once released for use Jan. 1, 2019, this will become the correct way to report Rezum.  

    How to report Rezum prior to Jan. 1, 2019 will likely be a topic of discussion, with different answers depending upon the payer. In the end, coverage and payment of this procedure will depend upon review of the clinical evidence by payers that is presented by urologists and patients that feel the procedure is the best clinical pathway to treat a patient’s BPH.

    Next: Two possible coding pathways

    Ray Painter, MD
    Urologist Ray Painter, MD, is president of Physician Reimbursement Systems, Inc., in Denver, and is also publisher of Urology Coding and ...
    Mark Painter
    Mark Painter is CEO of PRS Urology SC in Denver.

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