CPT® Code 0438T

Deleted

1. Indications

The transperineal placement of biodegradable material, as described by CPT® Code 0438T, is indicated for the following conditions:

• Prostate Cancer This procedure is performed as a preparatory step prior to radiation therapy, specifically to protect the rectal tissue from radiation damage during treatment.

2. Procedure

The procedure begins with the identification of the targeted area using transrectal ultrasound, which is performed in both longitudinal and transverse planes. This imaging technique allows the physician to visualize the perirectal fat located between Denonvilliers’ fascia and the anterior rectal wall. Once the appropriate site is confirmed, an 18 gauge needle is carefully inserted through the perineum and directed into the targeted area. To ensure correct placement of the needle, a small amount of saline is injected. This saline injection serves two purposes: it confirms the needle's position and facilitates hydrodissection of the space, creating a suitable environment for the subsequent injection of the biodegradable material. After confirming the needle's placement, syringes containing the biodegradable hydrogel material are connected to the needle. Under real-time ultrasound guidance, the hydrogel is injected into the designated area. The physician monitors the injection closely to ensure that the material is placed accurately. Once the injection is complete and satisfactory placement of the hydrogel spacer is confirmed, the needle is withdrawn. The hydrogel material rapidly solidifies into a soft, firm substance within seconds of injection, providing immediate protection. This spacer remains effective for approximately three months, after which it biodegrades, liquefies, and is absorbed by the body, with the remnants being excreted in the urine.

3. Post-Procedure

After the transperineal placement of the biodegradable material, patients are typically monitored for any immediate complications or adverse effects. It is essential to provide post-procedure care instructions, which may include recommendations for activity restrictions and signs of potential complications to watch for, such as infection or unusual discomfort. Patients can generally expect a recovery period during which the hydrogel spacer will remain effective in protecting the rectal tissue from radiation exposure. As the hydrogel biodegrades over approximately three months, patients should be informed that the material will be absorbed by the body and excreted in the urine. Follow-up appointments may be scheduled to assess the effectiveness of the procedure and to monitor the patient's overall treatment progress.