CPT® Code 0714T

Transperineal laser ablation (TPLA) is a medical procedure designed to treat benign prostatic hyperplasia (BPH), a condition characterized by the enlargement of the prostate gland that can lead to lower urinary tract symptoms in men. This minimally invasive technique utilizes targeted laser energy to thermally destroy hyperplastic prostate tissue while preserving the surrounding healthy glandular tissue. The procedure is performed on an outpatient basis, which means that patients can typically return home the same day, and it is associated with a lower risk of side effects compared to more invasive surgical options. TPLA can be repeated if necessary, making it a flexible treatment option for managing BPH. During the procedure, the laser energy is absorbed by the prostate tissue, generating heat that induces necrosis of the targeted areas within seconds. The effectiveness of the treatment is influenced by several factors, including the temperature, duration of heat transfer, and the depth of light distribution, which are determined by the specific wavelength of the laser used. To facilitate the procedure, a Foley catheter is placed to ensure proper drainage of urine. An ultrasound probe is typically inserted into the rectum to provide imaging guidance, and the procedure is usually performed under intravenous sedation combined with local anesthetic for patient comfort. A percutaneous catheter is inserted through the perineum to deliver an optical fiber equipped with a diffusing tip and a diode laser, which is surrounded by a cooling system connected to a flow circuit of sterile saline at room temperature. Using contrast-enhanced ultrasonography or MRI-fused images, the physician positions two to four laser fibers bilaterally in the transition zone of the prostate, parallel to the urethra, utilizing a needle guiding system. Once the fibers are correctly positioned, the needle is retracted to expose the fiber tips to the targeted tissue. If a medial lobe is present, a needle and laser fiber may also be placed there. The laser is initially activated at a lower power to confirm proper placement before the full treatment begins. Throughout the procedure, the physician closely monitors tissue necrosis and the temperature surrounding the treatment area to ensure safety. The laser delivery system is designed to automatically terminate the laser application if the temperatures at critical structures exceed predetermined limits. After the procedure is completed, the Foley catheter is removed, and the patient is monitored for a period before being discharged. It is important to report CPT® Code 0714T for cases involving a prostate volume of less than 50 mL, while CPT® Code 0867T should be used for prostate volumes greater than or equal to 50 mL.